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Wirbelsäulenfrakturen bei Mehrfachverletzten

Eine Analyse des DGU-Traumaregisters

Spinal fractures in multiply injured patients

An analysis of the German Trauma Society’s Trauma Register

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Zusammenfassung

Fragestellung

Im Verletzungsmuster mehrfach verletzter Patienten sind Frakturen der Wirbelsäule häufig. Um weitere Aufschlüsse über die Epidemiologie und den klinischen Verlauf dieser Entität zu erhalten, wurde das Traumaregister der DGU diesbezüglich ausgewertet. Das Register ist eine prospektive, standardisierte und anonymisierte Dokumentation schwerverletzter Patienten zu festgesetzten Zeitpunkten vom Unfallort bis zur Klinikentlassung.

Methodik

Aus dem Schwerverletztenregister der DGU (n=8057, Stand 07/2002) wurden 772 Patienten (10%) mit schwerem Wirbelsäulentrauma (AIS≥3) identifiziert. Männer waren mit 72% deutlich häufiger verletzt als Frauen (28%). Das mittlere Alter betrug 37±17 Jahre, der mittlere Verletzungsschweregrad betrug, berechnet nach dem ISS, 29±15 Punkte.

Ergebnisse

80% der Patienten waren zum Unfallzeitpunkt zwischen 15 und 54 Jahren alt, Verkehrsunfälle stellten die häufigste Unfallart dar (49%), gefolgt von Stürzen aus größerer Höhe (20%). Die HWS (34%), die BWS (40%) und die LWS (31%) waren annähernd gleich häufig verletzt. Bei nahezu der Hälfte der Patienten wurde die Wirbelsäule vom Notarzt präklinisch als unverletzt eingeschätzt. 20% der Patienten wiesen eine inkomplette und 27% eine komplette Querschnittssymptomatik auf. BWS-Verletzungen zeigten aufgrund des signifikant häufigeren gleichzeitigen Thoraxtrauma (96% vs. 37%) eine längere mittlere Verweildauer auf der Intensivstation. Patienten mit frühzeitiger WS-Operation (70% mit Operation <72 h nach Trauma) zeigten tendenziell kürzere Beatmungszeiten bzw. Verweildauern auf der Intensivstation und im Krankenhaus. 78% der Patienten überlebten 90 Tage nach Trauma.

Schlussfolgerung

Nahezu 10% aller dokumentierten Schwerverletzten im Traumaregister wiesen schwere Wirbelsäulenverletzungen auf. Diese Verletzungen wurden präklinisch häufig nicht diagnostiziert und somit unterschätzt. 70% der Patienten wurden frühzeitig (<72 h) nach Trauma an der Wirbelsäule operativ versorgt und zeigten kürzere Verweildauern. Diese Ergebnisse unterstützen frühere Publikationen, in denen tendenzielle Vorteile durch die frühe operative Stabilisierung der Wirbelfrakturen bei mehrfach verletzten Patienten nachgewiesen werden konnten.

Abstract

Objective

Spinal trauma is frequently found in multiply injured patients. To gain more insight into the epidemiology and the clinical course of this entity, we analyzed the relevant data held in the German Trauma Registry (German Trauma Society, DGU). The Registry provides prospective, standardized and anonymous documentation on severely injured patients at different predetermined time points from the site of the accident until they are discharged from hospital.

Methods

Out of 8,057 patients whose details are recorded in the German Trauma Registry, 772 (approximately 10%) with severe spine trauma (AIS≥3) patients were identified. Far more men (72%) than women (28%) had such spinal injuries. The mean age of the patients with severe spine injury was 37±17 years; their mean Injury Severity Score (ISS) was 29±15 (range 9–75) points.

Results

The age group 15–54 years was the largest (80%). Motor vehicle accidents (MVA) were the most frequent cause of severe spine trauma (49%), followed by falls from a great height (20%). About half of all severe spine injuries were not suspected in the prehospital setting. Symptoms of incomplete paraplegia were found in 20% of the patients and symptoms of complete paraplegia, in 27%. Patients with injuries to the thoracic spine more often had a lengthy average stay in the intensive care unit, because they were accompanied by thoracic trauma significantly more often than were injuries to the other spinal segments (96% vs 37%). Patients who underwent spinal surgery at an early stage (70% operated on <72 h after their injuries were sustained) showed a tendency to shorter periods ventilatory support and did not remain in the intensive care unit or indeed in the hospital as long as the other patients. Seventy-eight percent of the patients had survived for 90 days after sustaining their injuries.

Conclusion

Almost 10% of all documented cases of patients with severe injuries in the German Trauma Registry had severe spinal injuries. These injuries were frequently not recognized or their extent underestimated in the preclinical setting. About 70% underwent spine stabilization within 72 h after being injured. These results support previous findings suggesting that early stabilization of vertebral fractures might be beneficial in multiply injured patients.

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Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, BG-Kliniken Bergmannsheil,Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland

    C. Schinkel, T.M. Frangen & G. Muhr

  2. Chirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität,Klinikum Großhadern, München, Deutschland

    A. Kmetic & H.-J. Andress

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  1. C. Schinkel
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  2. T.M. Frangen
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  4. H.-J. Andress
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  5. G. Muhr
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AG Polytrauma der DGU

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Correspondence to C. Schinkel.

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Schinkel, C., Frangen, T., Kmetic, A. et al. Wirbelsäulenfrakturen bei Mehrfachverletzten. Unfallchirurg 110, 946–952 (2007). https://doi.org/10.1007/s00113-007-1351-2

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