PDF(Pubmed)
Abstract：
This study is to report the demographics, incidence, and patterns of spinal injuries associated with border crossings resulting from a fall from a significant height. A retrospective cohort study was performed at a Level I trauma center from January 2016 to December 2021 to identify all patients who fell from a significant height while traversing the U.S.-Mexico border and were subsequently admitted. A total of 448 patients were identified. Of the 448 patients, 117 (26.2%) had spine injuries and 39 (33.3%) underwent operative fixation. Females had a significantly higher incidence of spine injuries (60% vs. 40%; p < 0.00330). Patients with a spine fracture fell from a higher median fall height (6.1 vs. 4.6 m; p < 0.001), which resulted in longer median length of stay (LOS; 12 vs. 7 days; p < 0.001), greater median Injury Severity Score (ISS; 20 vs. 9; p < 0.001), and greater relative risk (RR) of ISS >15 (RR = 3.2; p < 0.001). Patients with operative spine injuries had significantly longer median intensive care unit (ICU) LOS than patients with non-operative spine injuries (4 vs. 2 days; p < 0.001). Patients with spinal cord injuries and ISS >15 sustained falls from a higher distance (median 6.1 vs. 5.5 m) and had a longer length of ICU stay (median 3 vs. 0 days). All patients with operative spine injuries had an ISS >15 relative to 50% of patients with non-operative spine injuries (median ISS 20 vs. 15; p < 0.001). Patients with spine trauma requiring surgery had a higher incidence of head (RR = 3.5; p 0.0353) and chest injuries (RR = 6.0; p = 0.0238), but a lower incidence of lower extremity injuries (RR = 0.5; p < 0.001). Thoracolumbar injuries occurred in 68.4% of all patients with spine injuries. Patients with operative spine injuries had a higher incidence of burst fracture (RR = 15.5; p < 0.001) and flexion-distraction injury (RR = 25.7; p = 0.0257). All patients with non-operative spine injuries had American Spinal Injury Association (ASIA) D or E presentations, and patients with operative spine injuries had a higher incidence of spinal cord injury: ASIA D or lower at time of presentation (RR = 6.3; p < 0.001). Falls from walls in border crossings result in significant injuries to the head, spine, long bones, and body, resulting in polytrauma casualties. Falls from higher height were associated with a higher frequency and severity of spinal injuries, greater ISS, and longer ICU length of stay. Operative spine injuries, compared with non-operative spine injuries, had longer ICU length of stay, greater ISS, and different fracture morphology. Spine surgeons and neurocritical care teams should be prepared to care for injuries associated with falls from height in this unique population.
摘要：
这项研究是为了报告人口统计学，发病率,以及与从高处坠落导致的越界相关的脊柱损伤模式。2016年1月至2021年12月，在I级创伤中心进行了一项回顾性队列研究，以确定所有在穿越美墨边境时从高处跌落并随后入院的患者。共确定了448名患者。在448名患者中，117例（26.2％）脊柱受伤，39例（33.3％）接受了手术固定。女性脊柱损伤的发生率明显较高(60%vs.40%；p<0.00330)。脊柱骨折患者从较高的中位跌倒高度（6.1vs.4.6米；p<0.001)，这导致中位住院时间更长(LOS；12vs.7天；p<0.001），更大的中位数伤害严重程度评分（ISS；20vs.9；p<0.001），ISS>15的相对风险（RR）更大（RR=3.2；p<0.001）。手术性脊柱损伤患者的中位重症监护病房（ICU）LOS明显长于非手术性脊柱损伤患者（4vs.2天；p<0.001）。脊髓损伤和ISS>15的患者从较高的距离持续跌倒（中位数6.1vs.5.5米)，ICU住院时间较长(中位数3vs.0天）。相对于50％的非手术脊柱损伤患者，所有手术脊柱损伤患者的ISS>15（中位ISS20与15；p<0.001）。需要手术的脊柱外伤患者头部损伤(RR=3.5;p=0.0353)和胸部损伤(RR=6.0;p=0.0238)的发生率更高，但下肢损伤的发生率较低（RR=0.5；p<0.001）。在所有脊柱损伤患者中，胸腰椎损伤发生率为68.4％。手术脊柱损伤患者爆裂骨折（RR=15.5；p<0.001）和屈曲牵张损伤（RR=25.7；p=0.0257）的发生率较高。所有非手术性脊柱损伤患者均接受美国脊柱损伤协会（ASIA）D或E演示，手术脊柱损伤患者的脊髓损伤发生率较高：出现时ASIAD或更低（RR=6.3；p<0.001）。过境点的墙壁坠落导致头部严重受伤，脊柱,长骨,和身体,导致多发性创伤伤亡。从较高的高度跌倒与较高的脊髓损伤的频率和严重程度有关，更大的国际空间站，ICU住院时间更长。手术性脊柱损伤,与非手术脊柱损伤相比，ICU住院时间更长，更大的国际空间站，和不同的断裂形态。脊柱外科医生和神经重症监护团队应做好准备，以照顾这一独特人群中与高处跌倒有关的伤害。
