شکستگی مهره در حوادث وسیله نقلیه موتوری تجزیه و تحلیل پزشکی و فنی از 33015 مجروح سرنشینان صندلی جلو

Spinal injuries pose a considerable risk to life and quality of life. In spite of improvements in active and passive safety of motor vehicles, car accidents are regarded as a major cause for vertebral fractures. The purpose of this study was to evaluate the current incidence of vertebral fractures among front-seat occupants in motor vehicle accidents, and to identify specific risk factors for sustaining vertebral fractures in motor vehicle accidents. Data from an accident research unit were accessed to collect collision details, preclinical data, and clinical data. We included all data on front-seat occupants. Hospital records were retrieved, and radiological images were evaluated. We analysed 33,015 front-seat occupants involved in motor vehicle accidents over a 24-year period. We identified 126 subjects (0.38%) with cervical spine fractures, 78 (0.24%) with thoracic fractures, and 99 (0.30%) with lumbar fractures. The mean relative collision speeds were 48, 39, and 40 kph in subjects with cervical, thoracic, and lumbar spine fractures, respectively, while it was 17.3 kph in the whole cohort. Contrary to the overall cohort, these patients typically sustained multiple hits rather than simple front collisions. Occupants with vertebral fractures frequently showed numerous concomitant injuries; for example, additional vertebral fractures. The incidence of vertebral fractures corresponded with collision speed. Safety belts were highly effective in the prevention of vertebral fractures. Apart from high speed, complex injury mechanisms as multiple collisions or rollovers were associated with vertebral fractures. Additional preventive measures should focus on these collision mechanisms.

Injuries of the spine are a considerable threat to life and quality of life. Compared to injuries of other organ systems, injuries to the spine and spinal cord are associated with the worst functional outcome and the lowest rate of reintegration into work and life activities (Johansson et al., 1993). Great efforts have been focused on improving the safety of cars for both drivers and passengers. The overall mortality in traffic accidents has been markedly reduced over the last few decades. For example, in the early 1990s, more than 10,000 road users were killed on German roads per year. In 2012, 3600 individuals died in traffic accidents; however, over 300,000 individuals were injured (German Federal Statistical Office, 2013). Nevertheless, motor vehicle accidents have been shown to be a frequent cause for spinal injuries (O’Connor, 2006, Bilston et al., 2011 and El-Faramawy et al., 2012). Wang et al. recently investigated the occurrence of spine fractures in hospital admissions following motor vehicle accidents. They found that 2530 out of 20,726 drivers or front-seat passengers of 16 years or older had sustained spinal fractures (12.5%) (Wang et al., 2009). Apart from databases of the US department of transportation there is little data available that both reveals the actual risk of sustaining vertebral fractures in motor vehicle accidents, and which crash circumstances contribute to these kinds of injuries (Pintar et al., 2012). In this study, we aim to evaluate the current risk for vertebral fractures among front-seat occupants in motor vehicle accidents, and to identify specific risk factors for sustaining vertebral fractures in motor vehicle accidents. This might serve as a basis for planning effective preventive measures.

Our data clearly showed that, apart from high speed, complex injury mechanisms with multiple collisions or rollovers were associated with vertebral fractures. Safety belts clearly play a major role in the prevention of vertebral fractures, but for multiple impacts or rollovers structural protection might remain insufficient. Standard crash tests do not include these situations; therefore we propose to introduce additional, more appropriate crash tests. Although the incidence of vertebral fractures was declining over the study period, we were unable to show a clear effect of improved passive safety of vehicles as impact speed decreased and age increased over the study period. In our study population, vertebral fractures were frequently accompanied by other injuries from all parts of the body. The clinical management of these patients therefore should include a thorough work-up of possible additional injuries.