Spinal injuries in pedestrians struck by motor vehicles
Spinal injuries in pedestrians struck by motor vehicles
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DOI：
10.1097/bsd.0b013e3181370703
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发表时间：
2008-06-01
影响因子：
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通讯作者：
Livingston, David
中科院分区：
文献类型：
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作者：
Vives, Michael J.;Kishan, Shyam;Livingston, David
研究设计：对 1997 年至 2003 年 6 年间连续被机动车撞伤并遭受脊柱损伤的患者进行回顾性研究。目的：确定被机动车撞伤的行人的脊髓损伤模式和相关伤害。背景数据摘要：涉及行人的机动车事故与高发病率和死亡率相关。方法：对所有在一级创伤和区域脊髓损伤中心收治的受伤患者进行回顾性审查，以识别被撞伤的患者机动车造成的脊柱持续损伤。 2001 年之前，胸腰椎 (TL) 的清除是通过 X 线平片进行的。从 2001 年开始，这种清除是通过胸部/腹部/骨盆的螺旋躯干计算机断层扫描 (CT/CAP) 进行的，目的是评估潜在的内脏损伤。 结果：在 1672 名被机动车撞到的患者中，135 名患者 (8%) 被发现有脊柱损伤。颈椎损伤占 35%，胸椎损伤占 19%，腰椎损伤占 37%，骶椎损伤占 27%。 99% 的患者存在相关损伤。通过相对风险分析，TL 脊柱损伤与胸部和腹部损伤之间没有区域关联。患者经常在较远的地方遭受多种损伤，大概是由于“双重冲击”损伤机制造成的。在开始 CT/CAP 方案清除 TL 脊柱之前，7% 的患者最初被 TL X 光片遗漏了损伤。 结论：与汽车乘员和摩托车手相比，被机动车撞到的行人的脊柱损伤在整个脊柱中分布更均匀，并且更经常与远端器官损伤共存，而汽车乘员和摩托车手的区域性倾向和孤立性脊柱损伤更常见。因此，有必要采用系统的诊断和治疗方法。螺旋躯干 CT 用于评估内脏损伤，可有效筛查 TL 骨折。
Study Design: Retrospective study of consecutive patients that were struck by motor vehicles and sustained spinal injuries over a 6-year period from 1997 to 2003.Objective: To determine spinal injury patterns and associated injuries in pedestrians struck by motor vehicles.Summary of Background Data: Motor vehicle accidents involving pedestrians are associated with high morbidity and mortality rates.Methods: All injured patients admitted to Level I Trauma and Regional Spinal Cord Injury Center were reviewed retrospectively to identify those who were struck by motor vehicles and sustained injury to the spinal column. Before 2001, clearance of the thoracolumbar (TL) spine was performed by plain radiographs. Beginning in 2001, such clearance was performed by helical truncal computed tomography of the chest/abdomen/pelvis (CT/CAP) that was performed to evaluate potential visceral injuries.Results: Of the 1672 patients who were struck by motor vehicles, 135 patients (8%) were found to have spinal injuries. Cervical injuries were found in 35%, thoracic in 19%, lumbar in 37%, and sacral injuries in 27%. Associated injuries were present in 99% of the patients. By relative risk analyses, there were no regional associations between injuries of the TL spine and injuries to the chest and abdomen. Patients frequently had combinations of injuries in distant locations, presumably from a "double-impact" injury mechanism. Before initiation of the CT/CAP protocol to clear the TL spine, 7% of patients had injuries initially missed by TL radiographs.Conclusions: Spinal injuries in pedestrians struck by motor vehicles are more evenly distributed throughout the spinal column and more often coexist with injuries to remote organs compared with car occupants and motorcyclists where regional tendencies and isolated spinal injuries are more frequent. A systematic approach to both diagnosis and treatment is, therefore, necessary. Helical truncal CT, performed to evaluate visceral injury, effectively screens for TL fractures.