Abstract：
METHODS: This study was a multicenter retrospective analysis of cervical spine gunshot wound (GSW) patients.
OBJECTIVE: The present study was conducted to evaluate the management and outcomes of vascular injuries following GSW involving the cervical spine.
BACKGROUND: Gunshot wounds (GSW) injuring the cervical spine are associated with high rates of vascular injury.
METHODS: Charts of patients with GSW involving the cervical spine at two Level 1 trauma centers were reviewed from 2010 to 2021 for demographics, injury characteristics, management and follow-up. Statistical analysis included T tests and ANOVA for comparisons of continuous variables and chi-square testing for categorical variables, non-parametric tests were used when indicated. Beta-binomial models were used to estimate the probabilities outcomes. Bayesian regression models were utilized to compute risk ratios (RR) and their 95 % confidence intervals (CI) to enhance the inferential robustness.
RESULTS: 40 patients with cervical spine GSW and associated cerebrovascular injury were included in our analysis. 15 % of patients had Biffl grade (BG) V injuries, 50 % grade IV, and 35 % grade III-I. Angiography was performed in 35 % of patients. 5 of these patients (BG V-III) required endovascular treatment for pseudoaneurysm obliteration or parent vessel sacrifice. 7 patients (22 %) showed evidence of progression. 70 % of patients were placed on antiplatelet therapy for stroke prevention. Bayesian regression models with a skeptical prior for cerebral ischemia revealed a mean RR of 4.82 (95 % CI 1.02-14.48) in the BG V group, 0.75 (95 % CI 0.13-2.26) in the BG IV group, and 0.61 (95 % CI 0.06-2.01) in the combined BG III-I group. For demise the mean RR was 3.41 (95 % CI 0.58-10.65) in the BG V group and 1.69 (95 % CI 0.29-5.97) in the BG IV group. In the high BG (V, IV) group, 54.55 % of patients treated with antiplatelet therapy had complications. None of the patients that were treated with antiplatelet therapy in the low BG (III-I) group had complications.
CONCLUSIONS: Cervical spine GSWs are associated with high-grade vascular injuries and may require early endovascular intervention. Additionally, a high rate of injury progression was seen on follow up imaging, requiring subsequent intervention. Reintervention and demise were common and observed in high BG (V, IV) groups. The incidence of stroke was low, especially in low BG (I-III) groups, suggesting that daily aspirin prophylaxis is adequate for long-term stroke prevention.
OBJECTIVE: The present study was conducted to evaluate the management and outcomes of vascular injuries following GSW involving the cervical spine.
BACKGROUND: Gunshot wounds (GSW) injuring the cervical spine are associated with high rates of vascular injury.
METHODS: Charts of patients with GSW involving the cervical spine at two Level 1 trauma centers were reviewed from 2010 to 2021 for demographics, injury characteristics, management and follow-up. Statistical analysis included T tests and ANOVA for comparisons of continuous variables and chi-square testing for categorical variables, non-parametric tests were used when indicated. Beta-binomial models were used to estimate the probabilities outcomes. Bayesian regression models were utilized to compute risk ratios (RR) and their 95 % confidence intervals (CI) to enhance the inferential robustness.
RESULTS: 40 patients with cervical spine GSW and associated cerebrovascular injury were included in our analysis. 15 % of patients had Biffl grade (BG) V injuries, 50 % grade IV, and 35 % grade III-I. Angiography was performed in 35 % of patients. 5 of these patients (BG V-III) required endovascular treatment for pseudoaneurysm obliteration or parent vessel sacrifice. 7 patients (22 %) showed evidence of progression. 70 % of patients were placed on antiplatelet therapy for stroke prevention. Bayesian regression models with a skeptical prior for cerebral ischemia revealed a mean RR of 4.82 (95 % CI 1.02-14.48) in the BG V group, 0.75 (95 % CI 0.13-2.26) in the BG IV group, and 0.61 (95 % CI 0.06-2.01) in the combined BG III-I group. For demise the mean RR was 3.41 (95 % CI 0.58-10.65) in the BG V group and 1.69 (95 % CI 0.29-5.97) in the BG IV group. In the high BG (V, IV) group, 54.55 % of patients treated with antiplatelet therapy had complications. None of the patients that were treated with antiplatelet therapy in the low BG (III-I) group had complications.
CONCLUSIONS: Cervical spine GSWs are associated with high-grade vascular injuries and may require early endovascular intervention. Additionally, a high rate of injury progression was seen on follow up imaging, requiring subsequent intervention. Reintervention and demise were common and observed in high BG (V, IV) groups. The incidence of stroke was low, especially in low BG (I-III) groups, suggesting that daily aspirin prophylaxis is adequate for long-term stroke prevention.
摘要：
方法：本研究是对颈椎枪伤（GSW）患者的多中心回顾性分析。
目的：本研究旨在评估累及颈椎的GSW后血管损伤的治疗和结果。
背景：枪伤（GSW）损伤颈椎与高血管损伤率相关。
方法：回顾了2010年至2021年两个1级创伤中心涉及颈椎的GSW患者的人口统计图，损伤特征,管理和跟进。统计分析包括用于比较连续变量的T检验和方差分析，以及用于分类变量的卡方检验。指示时使用非参数检验。使用β-二项模型来估计概率结果。利用贝叶斯回归模型来计算风险比（RR）及其95％置信区间（CI），以增强推理的稳健性。
结果：40例颈椎GSW和相关脑血管损伤患者被纳入我们的分析。15%的患者有Biffl(BG)V级损伤，50%四级,和35%的III-I级35%的患者进行了血管造影。这些患者中有5例（BGV-III）需要血管内治疗以进行假性动脉瘤闭塞或父母血管处死。7名患者（22％）显示出进展的证据。70%的患者接受抗血小板治疗以预防中风。在BGV组中，对脑缺血有怀疑态度的贝叶斯回归模型显示平均RR为4.82（95％CI1.02-14.48），BGIV组0.75（95%CI0.13-2.26），联合BGIII-I组和0.61（95％CI0.06-2.01）。对于死亡，BGV组的平均RR为3.41（95％CI0.58-10.65），BGIV组为1.69（95％CI0.29-5.97）。在高BG（V，IV)组，54.55%的抗血小板治疗患者出现并发症。低BG（III-I）组中接受抗血小板治疗的患者均未出现并发症。
结论：颈椎GSW与高度血管损伤相关，可能需要早期血管内介入治疗。此外,随访影像显示损伤进展率高，需要后续干预。在高BG（V，IV）组。中风的发生率很低,尤其是在低BG（I-III）组中，提示每日阿司匹林预防足以长期预防卒中.
目的：本研究旨在评估累及颈椎的GSW后血管损伤的治疗和结果。
背景：枪伤（GSW）损伤颈椎与高血管损伤率相关。
方法：回顾了2010年至2021年两个1级创伤中心涉及颈椎的GSW患者的人口统计图，损伤特征,管理和跟进。统计分析包括用于比较连续变量的T检验和方差分析，以及用于分类变量的卡方检验。指示时使用非参数检验。使用β-二项模型来估计概率结果。利用贝叶斯回归模型来计算风险比（RR）及其95％置信区间（CI），以增强推理的稳健性。
结果：40例颈椎GSW和相关脑血管损伤患者被纳入我们的分析。15%的患者有Biffl(BG)V级损伤，50%四级,和35%的III-I级35%的患者进行了血管造影。这些患者中有5例（BGV-III）需要血管内治疗以进行假性动脉瘤闭塞或父母血管处死。7名患者（22％）显示出进展的证据。70%的患者接受抗血小板治疗以预防中风。在BGV组中，对脑缺血有怀疑态度的贝叶斯回归模型显示平均RR为4.82（95％CI1.02-14.48），BGIV组0.75（95%CI0.13-2.26），联合BGIII-I组和0.61（95％CI0.06-2.01）。对于死亡，BGV组的平均RR为3.41（95％CI0.58-10.65），BGIV组为1.69（95％CI0.29-5.97）。在高BG（V，IV)组，54.55%的抗血小板治疗患者出现并发症。低BG（III-I）组中接受抗血小板治疗的患者均未出现并发症。
结论：颈椎GSW与高度血管损伤相关，可能需要早期血管内介入治疗。此外,随访影像显示损伤进展率高，需要后续干预。在高BG（V，IV）组。中风的发生率很低,尤其是在低BG（I-III）组中，提示每日阿司匹林预防足以长期预防卒中.
