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成人脊柱损伤的定义、发生机制及X线片表现

Authors
Amy Kaji, MD, PhD
Robert S Hockberger, MD, FACEP
Section Editor
Maria E Moreira, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
孔清泉, 主任医师，教授

引言

本专题描述了颈段、胸段和腰骶段的脊柱损伤，包括椎体的骨折、脱位和半脱位以及脊柱韧带的损伤。强调识别和处理脊柱损伤的重要性在于它与脊髓损伤密切相关。

脊柱损伤的处理以及其他脊髓损伤相关的问题将在别处讨论。(参见“成人颈段脊柱损伤评估和急性处理”和“急性创伤性脊髓损伤”和“脊髓病变的解剖学和定位”和“儿童和青少年颈椎损伤的评估”和“儿童或青少年运动员颈段脊髓和颈部外周神经损伤概述”)

流行病学

在被纳入一项大型创伤登记系统的患者中，约有3%的钝挫伤患者经受了脊柱损伤，如脊柱骨折或脱位；1%经受了脊髓损伤[1]。其他研究报道的脊柱损伤率为2%-6%[2]。头部创伤的患者和就诊时意识丧失的患者，脊柱损伤发生率可能显著升高。在严重创伤中心治疗的顿挫伤患者中，多达8%-15%可能发生胸腰椎骨折，包括棘突和横突骨折[3]。

一项对13项国际研究的系统评价发现：脊柱损伤发生率在不同国家之间，尤其在发达国家与发展中国家之间，差异很大(最高达3倍)[4,5]。大多数研究表明其发生率在年龄分布上呈双峰，第一个峰值在15-29岁的年轻人，第二个峰值在65岁以上的老年人。在老年患者中，死亡率显著升高[6]。脊柱损伤在男性中更常见。

需要注意的是，创伤登记的统计数据可能不完整、不准确，这取决于纳入标准，且有可能会低估脊柱损伤的实际患者数。例如，那些死于事故现场的受害者以及神经功能缺损快速改善的患者常常未被纳入其中。

                               

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Literature review current through: 2017-06 . | This topic last updated: 2016-07-13.
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