Williams J S, Graff J A, Uku J M, Steinig J P
Department of Surgical Education, Memorial Medical Center, Savannah, Georgia 31403-3089.
Ann Thorac Surg. 1994 Mar;57(3):726-30. doi: 10.1016/0003-4975(94)90576-2.
A 5-year retrospective study of 530 motor vehicle fatalities revealed 105 aortic injuries occurring in 90 victims. These were reviewed to determine the injury patterns, circumstances, and mechanisms involved. In addition, the survival time, the driver's age and sex, the time of day of the accident, and the blood alcohol level were considered. The aortic injuries consisted of 61 transections and 44 tears (13% were multiple). Sixty-five percent of the injuries were located in the proximal descending aorta (66% of these were transections), 14% were in the ascending aorta and arch (33% of these were transections), 12% were in the distal descending aorta (more than 1 cm distal to the subclavian artery) (46% of these were transections), and 9% were in the abdominal aorta (56% of these were transections). Associated injuries consisted of multiple rib fractures (78%), liver lacerations (61%), head injuries (42%), first rib fractures (42%), splenic lacerations (36%), heart lacerations (34%), sternal fractures (28%), cervical spine fractures (26%), and thoracic spine fractures (20%). Death occurred within 1 hour in 94% and within 24 hours in 99%. The impact was head-on in 62% of the accidents. The victim was the driver 74% of the time and male in 77% of the cases, and the blood alcohol level exceeded 0.1 mg/dL in 43%. Most aortic disruptions were complete transections of the proximal descending aorta, associated with serious injury to the thorax, and occurred in head-on collisions. Findings support a compression and upward thrust of the heart as a mechanism responsible for the aortic disruption.
一项对530例机动车死亡事故的5年回顾性研究显示，90名受害者发生了105处主动脉损伤。对这些损伤进行了审查，以确定损伤模式、情况和相关机制。此外，还考虑了生存时间、驾驶员的年龄和性别、事故发生的时间以及血液酒精水平。主动脉损伤包括61处横断伤和44处撕裂伤（13%为多处损伤）。65%的损伤位于降主动脉近端（其中66%为横断伤），14%位于升主动脉和主动脉弓（其中33%为横断伤），12%位于降主动脉远端（锁骨下动脉远端超过1厘米）（其中46%为横断伤），9%位于腹主动脉（其中56%为横断伤）。相关损伤包括多根肋骨骨折（78%）、肝裂伤（61%）、头部损伤（42%）、第一肋骨骨折（42%）、脾裂伤（36%）、心脏裂伤（34%）、胸骨骨折（28%）、颈椎骨折（26%）和胸椎骨折（20%）。94%的患者在1小时内死亡，99%在24小时内死亡。62%的事故为正面碰撞。74%的受害者为驾驶员，77%为男性，43%的血液酒精水平超过0.1mg/dL。大多数主动脉破裂为降主动脉近端的完全横断伤，与胸部严重损伤相关，发生在正面碰撞中。研究结果支持心脏的压缩和向上推力是导致主动脉破裂的机制。
