Kriss T C, Kriss V M
Department of Surgery, University of Kentucky Medical Center, Lexington 40536-0084, USA.
J Trauma. 1997 Jul;43(1):97-9. doi: 10.1097/00005373-199707000-00022.
Thirty million Americans ride horses; 50,000 of these riders are treated in emergency rooms annually. Equestrian activities are uniquely dangerous because the participant is unrestrained, often helmetless, and riding large, unpredictable animals capable of 40-mph speeds and kicking with up to 1 ton of force. Neurologic injuries in equestrians constitute the majority of severe injuries and fatalities. We prospectively studied all patients admitted to the University of Kentucky Medical Center with equine-related neurosurgical trauma from July 1992 to January 1996. Eighteen of 30 patients were male. Age ranged from 3 to 64 years. Five patients died (17%), and two suffered permanent paralysis. There were 24 head injuries (80%) and 9 spinal injuries (30%). The majority of injuries (60%) were caused by ejection or fall from the horse. Twelve patients (40%) were kicked by a horse, and four patients sustained crush injuries. Six patients underwent craniotomy, three had operative spinal stabilization, and five required ventriculostomy. Eleven patients (37%) were professional riders. Twenty-four patients (80%) were not wearing helmets, including all fatalities and craniotomy patients. Our data show that equine-related neurosurgical injuries can be severe and fatal because of the significant size, force, and unpredictability of these animals as well as the lack of proper headgear. We recommend that helmets be worn at all times around horses because a significant number of our patients (33%) were injured as bystanders. Risk of serious injury appears to be a function of cumulative exposure to horses, not level of expertise. Experience is not protective; helmets are.
三千万美国人骑马；其中每年有5000名骑手在急诊室接受治疗。马术活动具有独特的危险性，因为参与者没有束缚，常常不戴头盔，且骑乘的是大型、不可预测的动物，这些动物能以每小时40英里的速度奔跑，踢踹时力量可达1吨。马术运动中的神经损伤构成了重伤和死亡的主要部分。我们对1992年7月至1996年1月间因与马相关的神经外科创伤而入住肯塔基大学医学中心的所有患者进行了前瞻性研究。30名患者中有18名男性。年龄范围为3岁至64岁。5名患者死亡（17%），2名患者遭受永久性瘫痪。有24例头部损伤（80%）和9例脊柱损伤（30%）。大多数损伤（60%）是由从马背上被甩下或跌落所致。12名患者（40%）被马踢伤，4名患者遭受挤压伤。6名患者接受了开颅手术，3名患者进行了脊柱手术固定，5名患者需要进行脑室造瘘术。11名患者（37%）是职业骑手。24名患者（80%）未戴头盔，包括所有死亡患者和接受开颅手术的患者。我们的数据表明，由于这些动物体型巨大、力量惊人且不可预测，以及缺乏适当的头部装备，与马相关的神经外科损伤可能会很严重甚至致命。我们建议在马匹周围任何时候都要佩戴头盔，因为我们相当一部分患者（33%）是作为旁观者受伤的。严重受伤的风险似乎是与马匹累计接触的结果，而非专业水平。经验并不能起到保护作用；头盔才行。
