脊柱骨折类型与损伤方式的法医学分析

The association between type of spine fracture and the patterns of trauma on legal medicine field

目的脊柱骨折创伤类型与损伤方式的关系,是法医学领域上准确描述脊柱损伤的有效方法。我们的目的是以脊柱骨折的分型来确定创伤的方式。方法采用横断面调查,收集从2017年10月到2018年6月在某市附属医院急诊室,159名创伤性脊柱损伤伴或不伴有脊髓损伤的患者。基本材料通过医院的档案回顾性收集。结果在损伤方式方面,52.2%的骨折是由从高空坠落引起的,40.9%与机动车辆碰撞,其他由故意伤害造成。骨折部位:腰骶部占56.0%,胸部占29.6%,颈部占7.5%。就骨折类型而言,屈曲压缩骨折是最常见的骨折类型81例(50.9%),其次为爆裂骨折76例(47.8%)。骨折部位与损伤方式相关性:由高空坠落引起的最常见的伤害见于腰骶,交通事故中最常见的受伤在胸椎部位,故意伤害多发生在腰椎。骨折类型与损伤方式相关性:爆裂骨折更多地为患者从高处坠落和交通事故,交通事故和故意伤害中骨折类型均以屈曲压缩骨折为主。结论创伤性脊柱骨折的类型与损伤方式密切相关,可用于法医学鉴定中确定脊柱骨折病人的损伤方式。

Objective Determining the association between patterns of trauma,and the type of spine column fracture is a useful method for exactly describing spine injury on forensic medicine field.We supposed to determine patterns of trauma based on distribution of the transition of spinal column fractures.Methods This cross-sectional survey was performed on 159 patients with the history of spinal trauma who were admitted to emergency ward of Affiliated Hospital from October 2017 to June 2018.The baseline characteristics were collected by reviewing the hospital recorded files.Results With respect to patterns of fracture,52.2%of fractures were caused by falling,40.9%by collisions with motor vehicles,and others caused by the violence.Regarding site of fracture,lumbosacral was affected in 56.0%,thoracic in29.6%,and cervical in 7.5%.Regarding type of fracture,compressive fracture was the most common type(50.9%)followed by burst fracture(47.8%).The site of fracture was related to the patterns of injury;the most frequent injuries induced by falling from height were found in lumbosacral site,and the most common injuries by traffic accidents were found in thoracic site;and the injuries following violence were more revealed in lumbar vertebrae.The burst fractures were observed more in the patients affected by falling from height and by traffic accidents,and compressive fractures were revealed more in the patients injured with violence and traffic accidents.Conclusion The type of spine fracture due to trauma is specially associated with the patterns of trauma that can be useful in legal medicine to identify the injury patterns.