交通事故所致颈部损伤的诊断和治疗进展

doi:10.3969/j.issn.1006-9771.2020.12.012

摘要/Abstract

摘要：

交通事故所致颈部损伤逐年增加,及时而有效的救治可大大降低死亡率。本文综述交通事故致颈部损伤的特点、影像特征、诱发电位检测以及血清标志物检测方法等,进而对伤员的伤情综合考虑并具体分析,正确判断其轻重缓急,分清伤情、分类救治,有利于主治医生对患者进行精准和个性化的急救和手术治疗,最大限度抢救生命、减少残疾,同时预防和治疗交通事故所致的创伤后应激障碍。

关键词: 交通事故, 颈部损伤, 影像评估, 血清标志物, 诱发电位, 创伤后应激障碍, 综述

Abstract:

Neck injuries caused by traffic accidents increase by years, timely and effective treatment can greatly reduce the mortality rate. This paper summarized the characteristics, image features, evoked potential detection and serum markers detection of neck injury caused by traffic accidents. Then, the condition of injuries was comprehensively considered and analyzed, and the priorities were correctly judged. The injuries were classified and treated. It is conducive for the attending doctors to carry out precise individualized first aid and surgical treatment for the patients, in order to save lives to the maximum extent, reduce disabilities, and prevent and treat post traumatic stress disorders.

Key words: traffic accident, neck injuries, imaging evaluation, serum markers, evoked potential, post traumatic stress disorders, review

中图分类号:

熊翱,熊仁平,许建中. 交通事故所致颈部损伤的诊断和治疗进展[J]. 《中国康复理论与实践》, 2020, 26(12): 1439-1445.

XIONG Ao,XIONG Ren-ping,XU Jian-zhong. Neck Injuries by Traffic Accidents: Diagnosis and Treatment (review)[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(12): 1439-1445.

参考文献 72

[1]	王正国. 道路交通安全[J]. 交通医学, 2013, 272(2):107-109.
	Wang Z G. Road traffic safety[J]. Med J Communic, 2013, 272(2):107-109.
[2]	Stocchetti N. Traumatic brain injury: problems and opportunities[J]. Lancet Neurol, 2014, 13(1):14-16. doi: 10.1016/S1474-4422(13)70280-1 pmid: 24331787
[3]	顾海明, 李世成, 杨运生. Euro-NCAP追尾碰撞中颈部挥鞭伤试验方法研究[J]. 天津科技, 2015, 42(2):12-14.
	Gu H M, Li S C, Yang Y S. Study of Euro-NCAP whipplash test methods in rear-end collisions[J]. Tiajin Sci Technol, 2015, 42(2):12-14.
[4]	许留振. 两种术式治疗桡骨远端伴尺骨茎突骨折的临床研究[D]. 郑州:郑州大学, 2019.
	Xu L Z. Clinical study on the treatment of distal radius with ulnar styloid process fracture by two surgical methods[D]. Zhengzhou: Zhengzhou University, 2019.
[5]	王正国. 现代交通医学[M]. 重庆: 重庆出版社, 2011: 8-13, 39-63.
[6]	白茹, 陈明. 498例海口市道路交通事故死亡案例的法医学分析[J]. 法医学杂志, 2017(6):604-606.
	Bai R, Chen M. Forensic analysis of 498 death cases of road traffic accidents in Haikou City[J]. J Forensic Med, 2017(6):604-606.
[7]	刘城均, 曾丫平. 道路交通事故颌面部损伤的法医临床学应用研究[J]. 法制与社会, 2016(5):258-259.
	Liu C J, Zeng Y P. Forensic clinical application of maxillofacial injury in road traffic accidents[J]. Legal System Society, 2016 (5):258-259.
[8]	杜以良, 张维利. 道路交通事故死亡案例驾驶员损伤特征分析[J]. 法医学杂志, 2017, 33(1):36-37.
	Du Y L, Zhang W L. Analysis of driver injury characteristics in death cases of road traffic accidents[J]. J Forensic Med, 2017, 33(1):36-37.
[9]	李国良, 丁润涛. 轿车与轿车前部碰撞驾驶员和前排乘车人员损伤特征的比较研究[J]. 中国司法鉴定, 2018, 100(5):80-83.
	Li G L, Ding R T. Comparative study on injury characteristics of driver and front passenger in front of car and car collision[J]. Chin Judic Appr, 2018, 100(5):80-83.
[10]	张亮, 王鹏翔, 王增山, 等. C-NCAP 鞭打试验初定标准探讨[C]// 武汉:第八届国际汽车交通安全学术论坛, 2010: 395-398.
	Zhang L, Wang P X, Wang Z S, et al. Discussion on the preliminary standard of C-NCAP whipping test[C]// The 8th International Forum of Automotive Traffic Safety, 2010: 395-398.
[11]	商博, 乔维高. 汽车追尾碰撞中乘员颈部伤害的影响因素分析[J]. 上海汽车, 2009(1):44-46.
	Shang B, Qiao W G. Influencing factors of occupant neck injury in rear end collision[J]. Shanghai Automotive, 2009(1):44-46.
[12]	安帅, 范达, 姜保国, 等. 北京市"120"救治的0~25岁人群交通伤特点分析[J]. 中华创伤杂志, 2012, 28(1):16-19.
	An S, Fan D, Jiang B G, et al. Analysis of characteristics of traffic injuries in people aged 0-25 years treated by "120" in Beijing[J]. Chin J Trauma, 2012, 28(1):16-19.
[13]	张良, 周继红, 邱俊, 等. 2000~2006年重庆地区老年人道路交通伤害特点[J]. 重庆医学, 2011, 40(15):1457-1459.
	Zhang L, Zhou J H, Qiu J, et al. Characteristics of road traffic injuries among the elderly in Chongqing from 2000 to 2006[J]. Chongqing Med J, 2011, 40(15):1457-1459.
[14]	张良, 周继红, 李国灵, 等. 2000~2006年重庆地区0~19岁人群道路交通伤害特点与趋势[J]. 创伤外科杂志, 2011, 13(3):212-215.
	Zhang L, Zhou J H, Li G L, et al. Characteristics and trend of road traffic injuries among people aged 0-19 in Chongqing from 2000 to 2006[J]. J Trauma Surg, 2011, 13(3):212-215.
[15]	Gameui R L, Dries D J. Trauma 2000. Strategies for the New Millennium[M]. Austin: RG Landes Company, 2000: 1-10
[16]	Haegi M. A new deal for road crash victims[J]. BMJ, 2002, 324(7346):1110-1117. doi: 10.1136/bmj.324.7346.1110
[17]	蔡亚飞, 洪毅, 王方永, 等. 挥鞭样损伤的研究进展[J]. 中国康复理论与实践, 2019, 25(3):324-329.
	Cai Y F, Hong Y, Wang F Y, et al. Research progress of whiplash injury[J]. Chin J Rehabil Theory Pract, 2019, 25(3):324-329.
[18]	陈远清. 颈椎外伤伴颈脊髓损伤应用急诊急救及外科治疗的临床分析[J]. 数理医药学杂志, 2016, 29(2):209-210.
	Chen Y Q. Clinical analysis of emergency treatment and surgical treatment of cervical spine injury with cervical spinal cord injury[J]. J Mathem Med, 2016, 29(2):209-210.
[19]	林建军, 姚曙光, 邓雯苑, 等. 安全带对列车驾驶员的碰撞损伤防护研究[J]. 铁道科学与工程学报, 2017, 14(3):649-656.
	Lin J J, Yao S G, Deng W Y, et al. Research on collision damage protection of train drivers by safety belt[J]. J Railway Sci Eng J, 2017, 14(3):649-656.
[20]	仲衍慧, 李博, 殷为洋. 汽车碰撞乘员头部扭转伤害研究[J]. 天津科技, 2016, 43(11):32-35.
	Zhong Y H, Li B, Yin W Y. Research on head torsion injury of vehicle crash[J]. Tiajin Sci Technol, 2016, 43(11):32-35.
[21]	姜燕梅. 颈部损伤并发胸部外伤急诊患者的临床特征[J]. 健康研究, 2017, 37(4):451-452.
	Jiang Y M. Clinical characteristics of emergency patients with neck injury complicated with chest trauma[J]. Health Res, 2017, 37(4):451-452.
[22]	梁昌芬, 朱勇德, 林保冠, 等. 并发胸部创伤的颈椎损伤患者临床特征研究[J]. 检验医学与临床, 2017, 14(20):3023-3025.
	Liang C F, Zhu Y D, Lin B G, et al. Clinical characteristics of cervical spine injury complicated with thoracictrauma[J]. Lab Med Clin, 2017, 14(20):3023-3025.
[23]	Tanaka N, Atesok K, Nakanishi K, et al. Pathology and treatment of traumatic cervical spine syndrome: whiplash injury[J]. Adv Orthop, 2018, 47(65):50-56.
[24]	Chen J, Wang W, Han G, et al. MR investigation in evaluation of chronic whiplash alar ligament injury in elderly patients[J]. Zhong Nan Da Xue Xue Bao Yi Xue Ban, 2015, 40(1):67-71.
[25]	Radcliff K, Kepler C, Reitman C, et al. CT and MRI-based diagnosis of craniocervical dislocations:the role of the occipit0atlantal ligament[J]. Clin Orthop Relat Res, 2012, 470(6):1602-1613. doi: 10.1007/s11999-011-2151-0
[26]	Don S, De Kooning M, Voogt L, et al. The effect of visual feedback of the neck during movement in people with chronic whiplash-associated disorders: an experimental study[J]. J Orthop Sports Phys Ther, 2017, 47(3):190-199.
[27]	Ferrari R. A prospective study of the 1-year incidence of fibromyalgia after acute whiplash injury[J]. RMD Open, 2015, 1(1):1-5.
[28]	Peterson G, Nilsson D, Peterson S, et al. Changes in dorsal neck muscle function in individuals with chronic whiplash-as-sociated disorders: a real-time ultrasound case-control study[J]. Ultrasound Med Biol, 2016, 42(5):1090-1102. doi: 10.1016/j.ultrasmedbio.2015.12.022 pmid: 26921149
[29]	Ludvigsson M L, Peterson G, Dedering A, et al. One- and two-year follow-up of a randomized trial of neck-specific exercise with or without a behavioral approach compared with prescription of physical activity in chronic whiplash disorder[J]. J Rehabil Med, 2016, 48(10):56-64. doi: 10.2340/16501977-2041
[30]	De Reuck J. Motor evoked potentials in patients with chronic whiplash-associated disorder grade II[J]. Neurol Neurochir Pol, 2017, 51(5):372-374. doi: 10.1016/j.pjnns.2017.06.009
[31]	唐禾. 颈部挥鞭伤模拟实验研究[D]. 重庆:第三军医大学, 2004.
	Tang H. Experimental study on neck whiplash injury[D]. Chongqing: Third Military Medical University, 2004.
[32]	Pissonnier M L, Lazennec J Y, Renoux J, et al. Trauma of the upper cervical spine: focus on vertical atlantoaxial dislocation[J]. Eur Spine J, 2013, 22(10):2167-2175. doi: 10.1007/s00586-013-2841-2 pmid: 23838700
[33]	Peolsson A, Peterson G, Trygg J, et al. Multivariate analysis of ultrasound-recorded dorsal strain sequences: Investigation of dynamic neck extensions in women with chronic whiplash associated disorders[J]. Sci Rep, 2016, 3(6):304-315.
[34]	王玉明, 朱致敏, 车俊艳, 等. 完全脊髓损伤后血清S100B蛋白浓度变化[J]. 中国康复理论与实践, 2016, 22(7):824-826.
	Wang Y M, Zhu Z M, Che J Y, et al. Changes of serum S100B protein concentration after complete spinal cord injury[J]. Chin J Rehabil Theory Pract, 2016, 22(7):824-826.
[35]	Ahadi R, Khodaghdi F, Daneshi A, et al. Dagnostic value of serum levels of GFAP, pNF-H, and NSE compared with clinical findings in severity assessment of human traumatic spinal cord injury[J]. Spine, 2015, 40(14):E824-E830.
[36]	Landén Ludvigsson M, Peterson G, Jull G, et al. Mechanical properties of the trapezius during scapular elevation in people with chronic whiplash associated disorders: a case-control ultrasound speckle tracking analysis[J]. Man Ther, 2016, 21(1):177-182. doi: 10.1016/j.math.2015.07.009
[37]	Kalawy H, Stålnacke B M, Fahlström M, et al. New objective findings after whiplash injuries: high blood flow in painful cervical soft tissue: an ultrasound pilot study[J]. J Pain, 2017, 4:173-179.
[38]	Peterson G, Nilsson D, Trygg J, et al. Novel insights into the interplay between ventral neck muscles in individuals with whiplash-associated disorders[J]. Sci Rep, 2015, 5:15289-15298. doi: 10.1038/srep15289 pmid: 26472599
[39]	Peterson G, Nilsson D, Trygg J, et al. Neck-specific exercise improves impaired interactions between ventral neck muscles in chronic whiplash: a randomized controlled ultrasound study[J]. Sci Rep, 2018, 8(1):9649-9659. doi: 10.1038/s41598-018-27685-7 pmid: 29941911
[40]	Rebbeck T. The role of exercise and patient education in the noninvasive management of whiplash[J]. J Orthop Sports Phys Ther, 2017, 47(7):481-491. doi: 10.2519/jospt.2017.7138 pmid: 28622489
[41]	O'Leary S, Jull G , van Wyk L, et al. Morphological changes in the cervical muscles of women with chronic whiplash can be modified with exercise: a pilot study[J]. Muscle Nerve, 2015, 52(15):772-779. doi: 10.1002/mus.24612
[42]	叶彩林, 张婧婧, 钱银锋, 等. 颈段脊柱外伤的MRI评价与预后[J]. 临床放射学杂志, 2015, 34(9):1453-1456.
	Ye C L, Zhang J J, Qian Y F, et al. MRI evaluation and prognosis of cervical spinal trauma[J]. J Clin Radiol, 2015, 34(9):1453-1456.
[43]	栾飞, 陈建强. 枕颈交界区韧带急性损伤的影像诊断进展[J]. 实用放射学杂志, 2016, 32(6):967-969.
	Luan F, Chen J Q. Advances in imaging diagnosis of acute injury of occipitocervical ligament[J]. J Prac Radiol, 2016, 32(6):967-969.
[44]	Roy A K, Miller B A, Holland C M, et al. Magnetic resonance imaging of traumatic injury to the craniovertebral junction: a case-based review[J]. Neurosurg Focus, 2015, 38(4):E3.
[45]	叶彩林, 张婧婧, 钱银锋, 等. 颈段椎间盘损伤的MRI评价[J]. 实用放射学杂志, 2016, 32(11):1676-1680.
	Ye C L, Zhang J J, Qian Y F, et al. MRI evaluation of cervical intervertebral disc injury[J]. J Prac Radiol, 2016, 32(11):1676-1680.
[46]	Harald W, Christoph K, Gholam P, et al. Alterations of the biomarker S-100B and NSE in patients with acute vertebral spine fractures[J]. Spine J, 2014, 14(12):2918-2922. doi: 10.1016/j.spinee.2014.04.027 pmid: 24780247
[47]	Kim S Y, Kim T U, Lee S J, et al. Prognosis for patients with traumatic cervical spinal cord injury combined with cervical radiculopathy[J]. Ann Rehabil Med, 2014, 38(4):443-449. doi: 10.5535/arm.2014.38.4.443
[48]	Anderson S E, Boesch C, Zimmermann H, et al. Are there cervical spine findings at MR imaging that are specific to acute symptomatic whiplash injury? A prospective controlled study with four experienced blinded readers[J]. Radiology, 2012, 262(2):567-575. doi: 10.1148/radiol.11102115 pmid: 22187629
[49]	Lummel N, Bitterling H, Kloetzer A, et al. Value of "functional" magnetic resonance imaging in the diagnosis of ligamentous affection at the craniovertebral junction[J]. Eur J Radial, 2012, 81(11):3435-3440.
[50]	Wolf H, Christoph K, Gholam P, et al. Alterations of the biomarker S-100B and NSE in patients with acute vertebral spine fracture[J]. Spine J, 2014, 14(12):2918-2922. doi: 10.1016/j.spinee.2014.04.027
[51]	李水莉, 李颖, 赵丽丽, 等. 降阶梯思维方式在颅脑损伤合并颈椎损伤患者急救护理中应用的效果评价[J]. 中国实用护理杂志, 2015, 31(7):498-500.
	Li S L, Li Y, Zhao L L, et al. Evaluation of the effect of descending ladder thinking mode in emergency nursing of patients with craniocerebral injury and cervical spine injury[J]. Chin J Pract Nurs, 2015, 31(7):498-500.
[52]	汪红. 降阶梯思维方式用于颅脑损伤合并颈椎损伤患者急救护理的效果观察[J]. 中国卫生标准管理, 2016, 7(3):226-227.
	Wang H. Effect observation of descending ladder thinking mode on emergency nursing of patients with craniocerebral injury combined with cervical spine injury[J]. Chin Health Standard Manag, 2016, 7(3):226-227.
[53]	袁书伟, 罗天友, 吴景全, 等. 脊髓外伤的MRI与临床相关性分析[J]. 重庆医科大学学报, 2004, 29(2):194-196.
	Yuan S W, Luo T Y, Wu J Q, et al. MRI and clinical correlation analysis of spinal cord injury[J]. J Chongqing Med Univ, 2004, 29(2):194-196.
[54]	Umerani M S, Abbas A, Sharif S. Clinical outcome in patients with early versus delayed decompression in cervical spine trauma[J]. Asian Spine J, 2014, 8(4):427-434. doi: 10.4184/asj.2014.8.4.427
[55]	Li-Jun L, Ying-Chao H, Ming-Jie Y, et al. Biomechanical analysis of the longitudinal ligament of upper cervical spine in maintaining atlantoaxial stability[J]. Spinal Cord, 2014, 52(5):342-347. doi: 10.1038/sc.2014.8 pmid: 24614855
[56]	Martinez Perez R, Paredes I, Cepeda S, et al. Spinal cord injury after blunt cervical spine trauma: correlation of soft-tissue damage and extension of lesion[J]. Am J Neuroradiol, 2014, 35(5):1029-1034. doi: 10.3174/ajnr.A3812
[57]	Mei Q, Sui M, Xiao W, et al. Individualized endovascular treatment of high-grade traumatic vertebral artery injury[J]. Acta Neurochir (Wien), 2014, 156(9):1781-1788. doi: 10.1007/s00701-014-2074-0
[58]	Scott W W, Sharp S, Figueroa S A, et al. Clinical and radiological outcomes following traumatic grade 3 and 4 vertebral artery injuries: a 10-year retrospective analysis from a Level I trauma center. The Parkland Carotid and Vertebral Artery Injury Survey[J]. J Neurosurg, 2015, 122(5):1202-1207. doi: 10.3171/2014.9.JNS1461
[59]	Zoarski G H, Seth R. Safety of unilateral endovascular occlusion of the cervical segment of the vertebral artery without antecedent balloon test occlusion[J]. Am J Neuroradiol, 2014, 35(5):856-861. doi: 10.3174/ajnr.A3885 pmid: 24676007
[60]	叶虹, 侯振海, 施建国, 等. 道路交通事故致创伤后应激障碍的研究[J]. 中国康复理论与实践, 2009, 15(3):265-266.
	Ye H, Hou Z H, Shi J G, et al. Posttraumatic stress disorders after road traffic accident: a clinical investigation[J]. Chin J Rehabil Theory Pract, 2009, 15(3):265-266.
[61]	施建国, 侯振海, 周继红, 等. 高速公路交通伤后创伤后应激障碍分析[J]. 中华创伤杂志, 2006, 22(12):934-936.
	Shi J G, Hou Z H, Zhou J H, et al. Analysis of post-traumatic stress disorder after highway traffic injury[J]. Chin J Trauma, 2006, 22(12):934-936.
[62]	刘媛, 王正国, 伍亚民. 创伤后应激障碍的中枢神经系统机制[J]. 中国临床神经科学, 2008, 16(4):442-446.
	Liu Y, Wang Z G, Wu Y M. Central nervous system mechanism of posttraumatic stress disorder[J]. Chin J Clin Neurosci, 2008, L6(4):442-446.
[63]	Kalawy H, Stålnacke B M, Fahlstrom M, et al. New objective findings after whiplash injuries:High blood flow in painful cervical soft tissue:an ultrasound pilot study[J]. Scand J Pain, 2013, 4(4):173-179. doi: 10.1016/j.sjpain.2013.06.006
[64]	Persson M, Sörensen J, Gerdle B. Whiplash-associated disorders (WAD): responses to pharmacological challenges and psychometric tests[J]. Scand J Pain, 2012, 3(3):151-163. doi: 10.1016/j.sjpain.2012.01.003
[65]	Michaleff Z A, Maher C G, Lin C W, et al. Comprehensive physiotherapy exercise programme or advice for chronic whiplash (PROMISE): a pragmatic randomised controlled trial[J]. Lancet, 2014, 384(9938):133-141. doi: 10.1016/S0140-6736(14)60457-8 pmid: 24703832
[66]	Seferiades A, Ohlin P, Billhult A, et al. Basic body awareness therapy or exercise therapy for the treatment of chronic whiplash associated disorders: a randomized comparative clinical trial[J]. Disabil Rehabil, 2016, 38(15):442-451. doi: 10.3109/09638288.2015.1044036
[67]	Ludvigsson M L, Peterson G, O'Leary S, et al. The effect of neck-specific exercise with, or without a behavioral approach,on pain, disability, and self-efficacy in chronic whiplash-associ ated disorders: a randomized clinical trial[J]. Clin J Pain, 2015, 31(8):294-303. doi: 10.1097/AJP.0000000000000123
[68]	Griffin A, Leaver A, Moloney N, et al. General exercise does not improve long-term pain and disability in individuals with whiplash-associated disorders: a systematic review[J]. J Orthop Sports Phys Ther, 2017, 47(7):472-480.
[69]	Amiri Arimi S, Ghamkhar L, Kahlaee A H. The relevance of proprioception to chronic neck pain: a correlational analysis of flexor muscle size and endurance, clinical neck pain characteristics, and proprioception[J]. Pain Med, 2018, 93(10):331-342.
[70]	Hodges P W, Coppieters M W, MacDonald D, et al. New insight into motor adaptation to pain revealed by a combination of modelling and empirical approaches[J]. Eur J Pain, 2013, 17(35):1138-1146. doi: 10.1002/ejp.2013.17.issue-8
[71]	Hug F, Hodges P W, Tucker K J. Effect of pain location on spatial reorganisation of muscle activity[J]. J Electromyogr Kinesiol, 2013, 23(10):1413-1420. doi: 10.1016/j.jelekin.2013.08.014
[72]	Gizzi L, Muceli S, Petzke F, et al. Experimental muscle pain impairs the synergistic modular control of neck muscles[J]. PLoS One, 2015, 10(9):e0137844. doi: 10.1371/journal.pone.0137844