Spinal Fracture-Dislocations and Spinal Cord Injuries in Motor Vehicle Crashes

<b>Purpose:</b> This study estimated the annual count of spinal cord injuries (SCIs) in motor vehicles crashes by type and seat belt use using 18 years of NASS-CDS data. It determined the rate for SCI and fracture-dislocation of the spine.<b>Methods:</b> 1994–2011 NASS-CDS was used to estimate the annual occurrence of spinal injuries in front seat occupants involved in motor vehicle crashes. Crashes were grouped by front, side, rear, and rollovers, and the effects of belt use were investigated. Light vehicles were included with model year 1994+. Spinal injuries were classified as minor (Abbreviated Injury Scale [AIS] 1), moderate (AIS 2), serious (AIS 3), fracture-dislocations, and SCI (AIS 4+). The annual count and rate for different types of spinal injury were estimated along with standard errors. The results were compared to estimates of head injuries. NASS-CDS electronic cases of SCIs in rear impacts were investigated.<b>Results:</b> There were 5,592 ± 1,170 fracture-dislocations of the spine and 1,046 ± 193 AIS 4+ SCI per year in motor vehicle crashes. Most of the injuries occurred in rollovers and frontal crashes and the least occurred in rear impacts. The rate of SCI was 0.054 ± 0.010%. The highest rate was 0.220 ± 0.056% in rollover crashes and the lowest rate was 0.032 ± 0.009% in frontal crashes. The highest rate for spinal fracture-dislocation was 1.552 ± 0.455% in rollovers and the lowest was 0.065 ± 0.021% in rear impacts. The rate for SCI was 0.027 ± 0.005% in belted and 0.145 ± 0.028% in unbelted occupants giving 81% effectiveness of belt use in reducing SCI. The cervical spine was associated with 66.3 ± 11.3% of the AIS 4+ SCI with 30.5 ± 7.4% in the thoracic spine and 3.2 ± 1.3% in the lumbar spine. Severe head injuries occurred 13.3 times more often than SCIs.<b>Conclusions:</b> Spinal cord injury occurred in one out of 1,860 front seat occupants in tow-away crashes. The rate was highest in rollover crashes and was reduced by seat belt use. Fracture-dislocation of the spine occurred about 5.3 times more often than SCIs and was also prevented by seat belt use.

<b>研究目的：</b> 本研究基于18年的NASS-CDS（National Automotive Sampling System Crashworthiness Data System）数据，按损伤类型与安全带使用情况，估算机动车碰撞中脊髓损伤（Spinal Cord Injuries, SCI）的年发生例数，并确定脊髓损伤与脊柱骨折脱位的发生率。<b>研究方法：</b> 本研究采用1994-2011年的NASS-CDS数据，估算机动车碰撞中前排乘员的脊髓损伤年发生率。按正面碰撞、侧面碰撞、追尾碰撞及翻滚碰撞对事故进行分组，并探究安全带使用的影响。纳入1994年及之后款型的轻型车辆。脊髓损伤被分为轻度（简明损伤定级标准（Abbreviated Injury Scale, AIS）1级）、中度（AIS 2级）、重度（AIS 3级）、脊柱骨折脱位，以及AIS 4级及以上的脊髓损伤。估算不同类型脊髓损伤的年发生例数与发生率，并给出标准误。将研究结果与头部损伤的估算值进行对比。同时对NASS-CDS中追尾碰撞相关的脊髓损伤电子病例展开分析。<b>研究结果：</b> 机动车碰撞中，每年约发生5592±1170例脊柱骨折脱位，以及1046±193例AIS 4级及以上的脊髓损伤。此类损伤多发生于翻滚碰撞与正面碰撞，追尾碰撞中发生率最低。脊髓损伤的总体发生率为0.054±0.010%，其中翻滚碰撞中的发生率最高（0.220±0.056%），正面碰撞中的发生率最低（0.032±0.009%）。脊柱骨折脱位的最高发生率为1.552±0.455%，见于翻滚碰撞；最低发生率为0.065±0.021%，见于追尾碰撞。系安全带乘员的脊髓损伤发生率为0.027±0.005%，未系安全带者为0.145±0.028%，表明安全带使用可降低81%的脊髓损伤发生风险。AIS 4级及以上的脊髓损伤中，66.3±11.3%累及颈椎，30.5±7.4%累及胸椎，3.2±1.3%累及腰椎。重度头部损伤的发生频率是脊髓损伤的13.3倍。<b>研究结论：</b> 在拖离式碰撞的前排乘员中，每1860人中就有1人发生脊髓损伤。脊髓损伤发生率在翻滚碰撞中最高，且可通过系安全带降低。脊柱骨折脱位的发生频率约为脊髓损伤的5.3倍，同样可通过系安全带得到预防。