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Einfluss des Unfallmechanismus auf die Verletzungen der Halswirbelsäule

Influence of the trauma mechanism on cervical spine injuries

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Zusammenfassung

Hintergrund

Der Einfluss der Unfallkinematik auf die Verletzungen der Halswirbelsäule (HWS) findet in den gängigen Klassifikationssystemen neben dem Kraftvektor aktuell keine Berücksichtigung. Inwieweit die Unfallstärke einen zusätzlichen Einfluss auf Zahl und Komplexität der Verletzungen hat und ob sich dies klassifizieren lässt, ist noch nicht abschließend untersucht.

Fragestellung

Inwieweit hat neben der Kraftrichtung auch die Kraftstärke Einfluss auf Verletzungen der HWS?

Material und Methoden

Anhand der AOSpine-Klassifikationen für die obere und subaxiale HWS erfolgte eine retrospektive Fallauswertung von 134 Traumapatienten. Analog der S3-Polytrauma-Leitlinie erfolgten eine Zuordnung in 6 Unfallgruppen und die Einteilung der Verletzungsmorphologie anhand der CT-Schnittbildgebung.

Ergebnisse

Eine höhere Unfallenergie hat einen signifikanten Einfluss auf die Anzahl an Verletzungen (p = 0,005). Bei Niedrigrasanzunfällen ist C2 der am häufigsten verletzte Wirbelkörper (WK) (51 %; p = 0,022), bei Hochrasanzunfällen C7 (37 %; p = 0,017). Außerdem ließ sich zeigen, dass die obere HWS bei steigendem Alter und niedriger Unfallenergie vermehrt bei weiblichen (z. B. Sturz aus dem Stand) und die untere HWS bei Hochrasanzunfällen bei jüngeren männlichen Patienten verletzt ist (p = 0,012).

Schlussfolgerung

Eine genaue Kenntnis des Unfallmechanismus ist bei der Traumaversorgung hilfreich. Verletzungsmuster können besser abgeschätzt und die angemessene Diagnostik eingeleitet werden. Die Ergebnisse unterstreichen erneut die Wichtigkeit einer konsequenten HWS-Immobilisation auch bei Bagatelltraumata. Bei Hochrasanzunfällen ist die untere HWS häufiger verletzt, insbesondere C7. Aufgrund der Häufung mehrsegmentaler Verletzungen ist die radiologische Abklärung der gesamten WS nach Hochrasanztrauma zu empfehlen.

Abstract

Background

The influence of trauma-related kinematics on the injury pattern of the cervical spine is currently not considered in the available classification systems, only the force vector. Whether the strength of the trauma has an additional influence on the number and complexity of the injuries and whether this can be classified, has not yet been finally investigated.

Objective

What influence do different kinematics apart from the traumatic force vector have on injuries of the cervical spine?

Material and methods

Based on the AOSpine classification system for the upper and subaxial cervical spine, data from 134 trauma patients from a first level trauma center were retrospectively analyzed. Analogue to the S3 guidelines on polytrauma, patients were assigned to six trauma groups and the injuries were classified on the basis of computed tomography (CT) cross-sectional imaging.

Results

A higher trauma energy had a significant impact on the number of cervical spine injuries (p = 0.005). In low velocity accidents C2 was the most frequently injured vertebra (51%; p = 0.022) and high velocity accidents showed more C7 fractures (37%; p = 0.017). Furthermore, upper cervical spine injuries occurred more often in low energy trauma and older female patients (e.g. falling from a standing position). Subaxial cervical spine involvement was found significantly more often in high velocity accidents and younger male patients (p = 0.012).

Conclusion

Exact knowledge of the trauma mechanism is helpful in the primary treatment of an injured person. Injury patterns can be better estimated and the appropriate diagnostics can be initiated. The results underline the importance of immediate cervical spine immobilization even after minor trauma. In high velocity trauma, patients more often suffer from lower cervical spine injuries, especially C7. Due to the accumulation of multilevel spinal injuries in high velocity trauma, radiographic imaging of the whole spine is advisable.

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Abbreviations

BWS:

Brustwirbelsäule

C:

Halswirbelkörper

HWS:

Halswirbelsäule

LWS:

Lendenwirbelsäule

M:

Mittelwert

UFG:

Unfallgruppe

WK:

Wirbelkörper

WKF:

Wirbelkörperfraktur

WS:

Wirbelsäule

Literatur

  1. Almehmi A, Deliri H, Dameron J, Pfister AK (2005) Fracture of the osteoporotic cervical spine from a low-level trauma. W V Med J 101:71–72

    PubMed  Google Scholar 

  2. Báez AA, Schiebel N (2006) Evidence-based emergency medicine/systematic review abstract. Is routine spinal immobilization an effective intervention for trauma patients? Ann Emerg Med 47:110–112

    Article  Google Scholar 

  3. Ben-Galim P, Dreiangel N, Mattox KL et al (2010) Extrication collars can result in abnormal separation between vertebrae in the presence of a dissociative injury. J Trauma 69:447–450. https://doi.org/10.1097/TA.0b013e3181be785a

    Article  PubMed  Google Scholar 

  4. Berlemann U, Heini PF (2000) Cervical spine fractures and osteoporosis. In: Management of fractures in severely Osteoporotic Bone. Springer, London, S 206–213

    Chapter  Google Scholar 

  5. Boyle MJ (2007) Is mechanism of injury alone in the prehospital setting a predictor of major trauma – a review of the literature. J Trauma Manag Outcomes 1:4. https://doi.org/10.1186/1752-2897-1-4

    Article  PubMed  PubMed Central  Google Scholar 

  6. Brolin K, von Holst H (2002) Cervical injuries in Sweden, a national survey of patient data from 1987 to 1999. – PubMed – NCBI. Inj Control Saf Promot 9:40–52. https://doi.org/10.1076/icsp.9.1.40.3318

    Article  PubMed  Google Scholar 

  7. Buchinger W (1999) Vertebromedullary injuries in polytrauma. Anasthesiol Intensivmed Notfallmed Schmerzther 34(Suppl 1):S28–S31

    PubMed  Google Scholar 

  8. Burstein JL, Henry MC, Alicandro JM et al (1996) Evidence for and impact of selective reporting of trauma triage mechanism criteria. Acad Emerg Med 3:1011–1015

    Article  CAS  Google Scholar 

  9. Chapleau W, Al-Khatib J, Haskin D et al (2013) Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg. 74(5):1363–1366. https://doi.org/10.1097/TA.0b013e31828b82f5

    Article  Google Scholar 

  10. Conrad BP, Del Rossi G, Horodyski MB et al (2012) Eliminating log rolling as a spine trauma order. Surg Neurol Int 3:S188–S197. https://doi.org/10.4103/2152-7806.98584

    Article  PubMed  PubMed Central  Google Scholar 

  11. Costa e Silva L, Fragoso MI, Teles J (2017) Physical activity-related injury profile in children and adolescents according to their Age, maturation, and level of sports participation. Sports Health 9:118–125. https://doi.org/10.1177/1941738116686964

    Article  PubMed  PubMed Central  Google Scholar 

  12. Coutinho ES, Fletcher A, Bloch KV, Rodrigues LC (2008) Risk factors for falls with severe fracture in elderly people living in a middle-income country: a case control study. BMC Geriatr 8:21. https://doi.org/10.1186/1471-2318-8-21

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Daffner RH, Deeb ZL, Rothfus WE (1986) „Fingerprints“ of vertebral trauma--a unifying concept based on mechanisms. Skeletal Radiol 15:518–525

    Article  CAS  Google Scholar 

  14. Daffner RH, Goldberg AL, Evans TC et al (1998) Cervical vertebral injuries in the elderly: a 10-year study. Emerg Radiol 5:38–42. https://doi.org/10.1007/BF02749124

    Article  Google Scholar 

  15. Demontiero O, Vidal C, Duque G (2012) Aging and bone loss: new insights for the clinician. Ther Adv Musculoskelet Dis 4:61–76. https://doi.org/10.1177/1759720X11430858

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Dempster WT (1955) Space requirements of the seated operator, geometrical, kinematic, and mechanical aspects of the body with special reference to the limbs

    Book  Google Scholar 

  17. Edward PG, Heming SDJ, Kevin T, Michael F (2018) Cervical spine immobilisation in the elderly: a literature review. Br J Neurosurg. https://doi.org/10.1080/02688697.2018.1445828

    Article  Google Scholar 

  18. Fielding JW, Cochran GVB, Lawsing JF, Hohl M (1974) Tears of the transverse ligament of the atlas. A clinical and biomechanical study. J Bone Joint Surg Am 56:1683–1691

    Article  CAS  Google Scholar 

  19. Fredø HL, Rizvi SAM, Lied B et al (2012) The epidemiology of traumatic cervical spine fractures: a prospective population study from Norway. Scand J Trauma Resusc Emerg Med 20:85. https://doi.org/10.1186/1757-7241-20-85

    Article  PubMed  PubMed Central  Google Scholar 

  20. Harless E (1857) Die statischen Momente der menschlichen Gliedmassen

    Google Scholar 

  21. Hasler RM, Exadaktylos AK, Bouamra O et al (2011) Epidemiology and predictors of spinal injury in adult major trauma patients: European cohort study. Eur Spine J 20:2174–2180. https://doi.org/10.1007/s00586-011-1866-7

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hauswald M, Ong G, Tandberg D, Omar Z (1998) Out-of-hospital spinal immobilization: its effect on neurologic injury. Acad Emerg Med 5:214–219

    Article  CAS  Google Scholar 

  23. Hu R, Mustard CA, Burns C (1996) Epidemiology of incident spinal fracture in a complete population. Spine 21:492–499

    Article  CAS  Google Scholar 

  24. Jacobs C, Jacobs C, Hartwig T et al (2018) Influence of trauma mechanisms on thoracic and lumbar spinal fractures. Unfallchirurg 121:739–746. https://doi.org/10.1007/s00113-017-0424-0

    Article  PubMed  Google Scholar 

  25. Jubert P, Lonjon G, de Loubresse CG (2013) Complications of upper cervical spine trauma in elderly subjects. A systematic review of the literature. Orthop Traumatol Surg Res 43:S301–S312. https://doi.org/10.1016/j.otsr.2013.07.007

    Article  Google Scholar 

  26. King AI (2018) The biomechanics of impact injury. Springer, Cham

    Book  Google Scholar 

  27. Kreinest M, Gliwitzky B, Goller S, Münzberg M (2015) Pre-clinical spinal immobilisation. Notfall Rettungsmed 19:41–47. https://doi.org/10.1007/s10049-015-0118-5

    Article  Google Scholar 

  28. Kreinest M, Goller S, Rauch G et al (2016) Parameters influencing the preclinical application of cervical collars. Unfallchirurg 120:675–682. https://doi.org/10.1007/s00113-016-0207-z

    Article  Google Scholar 

  29. Lenehan B, Boran S, Street J et al (2009) Demographics of acute admissions to a National Spinal Injuries Unit. Eur Spine J 18:938–942

    Article  CAS  Google Scholar 

  30. Leucht P, Fischer K, Muhr G, Mueller EJ (2009) Epidemiology of traumatic spine fractures. Injury 40:166–172. https://doi.org/10.1016/j.injury.2008.06.040

    Article  PubMed  Google Scholar 

  31. Lomoschitz FM, Blackmore CC, Mirza SK, Mann FA (2002) Cervical spine injuries in patients 65 years old and older: epidemiologic analysis regarding the effects of age and injury mechanism on distribution, type, and stability of injuries. AJR Am J Roentgenol 178:573–577. https://doi.org/10.2214/ajr.178.3.1780573

    Article  CAS  PubMed  Google Scholar 

  32. Mertz HJ, Patrick LM (1971) Strength and response of the human neck. SAE Technical Paper, Bd. 1, S 710855 https://doi.org/10.4271/710855

    Book  Google Scholar 

  33. Oteir AO, Smith K, Jennings PA, Stoelwinder JU (2014) The prehospital management of suspected spinal cord injury: an update. Prehosp Disaster Med 29:399–402. https://doi.org/10.1017/S1049023X14000752

    Article  PubMed  Google Scholar 

  34. Rao PJ, Phan K, Mobbs RJ et al (2016) Cervical spine immobilization in the elderly population. J Spine Surg 2:41–46. https://doi.org/10.21037/jss.2016.02.02

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ruchholtz S, Nast-Kolb D, Waydhas C, Schweiberer L (1996) Das Verletzungsmuster beim Polytrauma. Unfallchirurg 99:633–641. https://doi.org/10.1007/s001130050036

    Article  CAS  PubMed  Google Scholar 

  36. Schinkel C, Frangen TM, Kmetic A et al (2007) Spinal fractures in multiply injured patients. Unfallchirurg 110:946–952. https://doi.org/10.1007/s00113-007-1351-2

    Article  CAS  PubMed  Google Scholar 

  37. Spivak JM, Weiss MA, Cotler JM, Call M (1994) Cervical spine injuries in patients 65 and older. Spine 19:2302–2306

    Article  CAS  Google Scholar 

  38. Steel H (1968) Anatomical and mechanical considerations of the atlantoaxial articulations. J Bone Joint Surg Am 50:1481–1482

    Google Scholar 

  39. Tadghare J, Rege SV, Nigam M (2017) Incidence of cervical spine injury observed in polytrauma patients at autopsy. J Spine Surg 4:173–177. https://doi.org/10.5005/jp-journals-10039-1154

    Article  Google Scholar 

  40. Unfallchirurgie D (2016) S3-Leitlinie Polytrauma. Schwerverletzten-Behandlung AWMF-Register

    Google Scholar 

  41. Vaccaro AR, Koerner JD, Radcliff KE et al (2015) AOSpine subaxial cervical spine injury classification system. Eur Spine J 25:2173–2184. https://doi.org/10.1007/s00586-015-3831-3

    Article  PubMed  Google Scholar 

  42. van der Roer N, de Bruyne MC, Bakker FC et al (2009) Direct medical costs of traumatic thoracolumbar spine fractures. Acta Orthop 76:662–666. https://doi.org/10.1080/17453670510041745

    Article  Google Scholar 

  43. Volle E (2009) Die Verletzung des kraniozervikalen Übergangs (KZÜ). In: Graf M, Grill C, Wedig H‑D (Hrsg) Beschleunigungsverletzung der Halswirbelsäule: „HWS-Schleudertrauma“. Steinkopff, Darmstadt, S 141–149

    Google Scholar 

  44. Wang H (2013) Geriatric trauma patients with cervical spine fractures due to ground level fall: five years experience in a level one trauma center. J Clin Med Res 5:75–83. https://doi.org/10.4021/jocmr1227w

    Article  PubMed  PubMed Central  Google Scholar 

  45. Winslow JE III, Hensberry R, Bozeman WP et al (2006) Risk of thoracolumbar fractures doubled in victims of motor vehicle collisions with cervical spine fractures. J Trauma 61:686–687. https://doi.org/10.1097/01.ta.0000196925.99822.37

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland

    S. Scheidt, P. P. Roessler, S. Pedrood, M. Jaenisch, D. Cucchi, C. Burger & C. Jacobs

  2. Klinik für Radiologie, Universitätsklinikum Bonn, Bonn, Deutschland

    M. Marinova

  3. Institut für Medizinische Mikrobiologie, Immunologie und Parasitologie, Universitätsklinikum Bonn, Bonn, Deutschland

    G. Hischebeth

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S. Scheidt, P.P. Roessler, S. Pedrood, M. Marinova, M. Jaenisch, D. Cucchi, G. Hischebeth, C. Burger und C. Jacobs geben an, dass kein Interessenkonflikt besteht.

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Scheidt, S., Roessler, P.P., Pedrood, S. et al. Einfluss des Unfallmechanismus auf die Verletzungen der Halswirbelsäule. Unfallchirurg 122, 958–966 (2019). https://doi.org/10.1007/s00113-019-0622-z

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