背景:尸体和较早的影像学研究表明,并发颈椎骨折在头部枪伤(GSWs)中很少见。尽管有这些知识,患有颅面GSW的患者通常会出现脊柱运动受限(SMR)。这项研究量化了GSW头部颈椎损伤的发生率,使用计算机断层扫描(CT)识别。假设骨折频率在自伤(SI)中更低。
方法:从2013-2017年的I级创伤中心登记处和2012-2016年的美国国家创伤数据库(NTDB)查询了孤立的颅面GSW(头部或面部缩写损伤量表[AIS]>2)。数据集包括年龄,性别,SI与不是,颈椎损伤,脊柱手术,和死亡率。对于这家医院的数据,院前因素,SMR,和CT进行了评估。用Stata软件进行统计评价,P<0.05显著。
结果:包括来自该医院的两百四十一名患者(平均年龄39岁;85%男性;66%SI)和来自NTDB的5,849名患者(平均年龄38岁;84%男性;53%SI)。对于这两个队列,SI患者年龄较大(P<0.01),死亡率增加(P<0.01)。总的来说,颈椎骨折发生率为3.7%,5.4%需要脊柱手术(占所有患者的0.2%)。非SI的骨折频率高五倍(P<0.05)。本地,SMR在到达之前出现在121(50.2%)中,并在创伤湾中放置了六个项圈(2.5%)。无论SI状态如何,SMR的频率相似(49.0%对51.0%;P=不显着),但在低血压患者和接受心肺复苏(CPR)的患者中频率较低。SMR的存在与颈椎CT的使用增加有关(80.0%对33.0%;P<0.01)。
结论:在头部和面部的孤立性GSW中,颈椎骨折的发生率不到4%,在非SI病例中更常见。在符合SI损伤的情况下,应避免院前SMR。对于所有其他人,一旦CT成像完成阴性结果,应停止SMR。
BACKGROUND: Cadaveric and older radiographic studies suggest that concurrent cervical spine fractures are rare in gunshot wounds (GSWs) to the head. Despite this knowledge, patients with craniofacial GSWs often arrive with spinal motion restriction (SMR) in place. This study quantifies the incidence of cervical spine injuries in GSWs to the head, identified using computerized tomography (CT). Fracture frequency is hypothesized to be lower in self-inflicted (SI) injuries.
METHODS: Isolated craniofacial GSWs were queried from this Level I trauma center registry from 2013-2017 and the US National Trauma Data Bank (NTDB) from 2012-2016 (head or face abbreviated injury scale [AIS] >2). Datasets included age, gender, SI versus not, cervical spine injury, spinal surgery, and mortality. For this hospital\'s data, prehospital factors, SMR, and CTs performed were assessed. Statistical evaluation was done with Stata software, with P <.05 significant.
RESULTS: Two-hundred forty-one patients from this hospital (mean age 39; 85% male; 66% SI) and 5,849 from the NTDB (mean age 38; 84% male; 53% SI) were included. For both cohorts, SI patients were older (P < .01) and had increased mortality (P < .01). Overall, cervical spine fractures occurred in 3.7%, with 5.4% requiring spinal surgery (0.2% of all patients). The frequency of fracture was five-fold greater in non-SI (P < .05). Locally, SMR was present in 121 (50.2%) prior to arrival with six collars (2.5%) placed in the trauma bay. Frequency of SMR was similar regardless of SI status (49.0% versus 51.0%; P = not significant) but less frequent in hypotensive patients and those receiving cardiopulmonary resuscitation (CPR). The presence of SMR was associated with an increased use of CT of the cervical spine (80.0% versus 33.0%; P < .01).
CONCLUSIONS: Cervical spine fractures were identified in less than four percent of isolated GSWs to the head and face, more frequently in non-SI cases. Prehospital SMR should be avoided in cases consistent with SI injury, and for all others, SMR should be discontinued once CT imaging is completed with negative results.