Hoang Kim, Santos Jeffrey, Grigorian Areg, Swentek Lourdes, Bow Hansen, Nahmias Jeffry
University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
University of California, Irvine, Department of Neurological Surgery, Orange, California, USA.
Neurocirugia (Engl Ed). 2025 May-Jun;36(3):145-150. doi: 10.1016/j.neucie.2024.09.003. Epub 2024 Sep 30.
Halo braces treat upper cervical spine fractures and serve as the most rigid form of external immobilization. Recently, halo braces have lost favor due to known complications and advances in surgical stabilization. This study aims to determine the contemporary incidence for use of halo braces and identify risk factors associated with mortality in trauma patients undergoing halo brace for cervical spine fractures.
The 2017-2019 Trauma Quality Improvement Program Database was queried for patients ≥18 years-old with a cervical spine fracture undergoing halo brace. Patients sustaining penetrating trauma and severe torso injuries (abbreviated injury scale >3 for the abdomen or thorax) were excluded. Bivariate and multivariable logistic regression analyses were performed.
From 144,434 patients with a cervical spine fracture, 272 (0.2%) underwent halo brace and 14 (5%) of these died. Those who died were older (73.5 vs. 53 years-old, p = 0.011) and had higher rates of hypertension (78.6% vs 33.1%, p < 0.001) and chronic kidney disease (14.3% vs. 1.2%, p < 0.001). Glasgow Coma Scale ≤8 (46.2% vs. 8.2%, p < 0.001) and cervical spinal cord injury (71.4% vs. 21.3%, p < 0.001) were more common in patients who died. In addition, those who died more often sustained respiratory complications (7.1% vs. 0.4%, p = 0.004) and sepsis (7.1% vs. 0.4%, p = 0.004). On multivariable logistic regression analysis, only Glasgow Coma Scale ≤8 (OR 19.77, 3.04-128.45, p = 0.002) was associated with increased mortality.
Only 5% of cervical spine fracture patients undergoing halo brace died. Respiratory complications and sepsis were more common in those who died. On multivariable analysis only Glasgow Coma Scale ≤8 remained an independent associated risk factor for mortality.
头环支具用于治疗上颈椎骨折，是最坚固的外固定形式。近来，由于已知的并发症以及手术固定技术的进步，头环支具已不再受青睐。本研究旨在确定头环支具的当代使用发生率，并识别接受头环支具治疗颈椎骨折的创伤患者中与死亡率相关的危险因素。
查询2017 - 2019年创伤质量改进计划数据库，纳入年龄≥18岁且接受头环支具治疗颈椎骨折的患者。排除遭受穿透性创伤和严重躯干损伤（腹部或胸部简明损伤定级>3）的患者。进行双变量和多变量逻辑回归分析。
在144,434例颈椎骨折患者中，272例（0.2%）接受了头环支具治疗，其中14例（5%）死亡。死亡患者年龄更大（73.5岁对53岁，p = 0.011），高血压发生率更高（78.6%对33.1%，p < 0.001），慢性肾脏病发生率更高（14.3%对1.2%，p < 0.001）。格拉斯哥昏迷量表评分≤8分（46.2%对8.2%，p < 0.001）和颈脊髓损伤（71.4%对21.3%，p < 0.001）在死亡患者中更常见。此外，死亡患者更常发生呼吸并发症（7.1%对0.4%，p = 0.004）和脓毒症（7.1%对0.4%，p = 0.004）。多变量逻辑回归分析显示，只有格拉斯哥昏迷量表评分≤8分（比值比19.77，3.04 - 128.45，p = 0.002）与死亡率增加相关。
接受头环支具治疗的颈椎骨折患者中只有5%死亡。呼吸并发症和脓毒症在死亡患者中更常见。多变量分析中，只有格拉斯哥昏迷量表评分≤8分仍然是死亡率的独立相关危险因素。
