Meenen N M, Katzer A, Dihlmann S W, Held S, Fyfe I, Jungbluth K H
Abteilung für Unfall- und Wiederherstellungschirurgie, Universitätskrankenhaus Hamburg-Eppendorf.
Unfallchirurgie. 1994 Jun;20(3):138-48; discussion 149. doi: 10.1007/BF02588158.
Radiological investigations contribute little in differentiating the problems of patients with whiplash injuries. Nevertheless the more prolonged cases of whiplash injuries must not be attributed to preexisting degenerative disease, despite radiologically-proven medicolegal opinion. In this study, 60 patients who were seen for whiplash injuries in the Department for Trauma and Reconstructive Surgery at the University Hospital Hamburg-Eppendorf for clinical and radiological evaluation, an average of 5.7 years post injury, were divided into two groups (n = 30) depending on radiologically-proven preexisting degenerative changes of the cervical spine. On average the patients with degenerative changes were 11.2 years older than those with healthy vertebral columns and also demonstrated an increase in acute symptoms in the lower cervical spine (cervicobrachial syndrome). The chronicity of individual symptoms such as neck-pain, dizziness, nausea and psychological illness was also observed in both groups. Problems such as paresthesias as well as pain in the shoulder-arm-area appeared to increase in subsequent check-ups, irrespective of the earlier degenerative changes. Patients with typical posterior headaches recovered faster when they had radiologically normal spines. Presenting late, there was a significant accumulation of patients with pre-existing degenerative changes complaining merely of tinnitus. The earlier changes in any individual motion segment do not determine the clinical course of whiplash injuries, but merely represent an area of increased vulnerability to trauma. On the other hand, trauma has not been proven to influence the development or aggravation of degenerative changes in normal or diseased spines. We are not able to differentiate the posttraumatic course from the natural history of the degenerative process, either clinically or radiologically. Considering the involvement of sensitive neurological structures the classical objective organic diagnosis of "whiplash injury" may not be adequate in describing the complaints of patients, and should not be used to justify the rejection of the patients subjective symptoms as mere simulation for financial gains. The evaluation of the patients' X-rays using Arlen's technique sheds no further light on the issue.
放射学检查在鉴别挥鞭样损伤患者的问题方面作用不大。然而，尽管有放射学证实的法医学观点，但挥鞭样损伤病程较长的病例不应归因于先前存在的退行性疾病。在本研究中，60例因挥鞭样损伤在汉堡-埃彭多夫大学医院创伤与重建外科就诊，平均受伤后5.7年接受临床和放射学评估的患者，根据放射学证实的颈椎先前存在的退行性改变分为两组（每组n = 30）。平均而言，有退行性改变的患者比脊柱健康的患者大11.2岁，并且下颈椎（颈臂综合征）的急性症状也有所增加。两组均观察到颈部疼痛、头晕、恶心和心理疾病等个体症状的慢性化。感觉异常以及肩臂区域疼痛等问题在后续检查中似乎有所增加，与早期的退行性改变无关。脊柱放射学正常的典型后头痛患者恢复得更快。就诊较晚时，先前存在退行性改变且仅主诉耳鸣的患者明显增多。任何单个运动节段的早期改变并不能决定挥鞭样损伤的临床病程，而仅仅代表创伤易感性增加的区域。另一方面，尚未证实创伤会影响正常或患病脊柱退行性改变的发展或加重。无论是在临床还是放射学方面，我们都无法区分创伤后病程与退行性过程的自然史。考虑到敏感神经结构的受累情况，“挥鞭样损伤”经典的客观器质性诊断可能不足以描述患者的主诉，不应以此为由将患者的主观症状视为单纯为获取经济利益而进行的伪装而予以驳回。使用阿伦技术对患者的X线片进行评估并不能进一步阐明该问题。
