Evaluation of the test-retest repeatability of the Injury Severity Perception score in patients with acute whiplash-associated disorder

Objective： To determine the test retest repeatability of the Injttry Severity Perception （ISP） score in participants with acute whiplash-associated disorders （WADs）. Methods： Consecutive patients with WAD, presenting in the acute stage to a primary care center, were asked to complete the 1SP score. ISP was measured with a numerical rating scale that ranged from 0 to 10, on which subjects were asked to rate how severe （in terms of damage） they thought their injury was. The anchors were labeled ＂no damage＂ （0） and ＂severe, and maybe permanent damage＂ （10）. The ISP questionnaire was administered to the participants at the time of recruitment and again 7 days later. Repeatability was evaluated by calculating percentage agreement and Cohen kappa statistic between the two time points of measurement. Results： A total of 94 subjects （34 males, 60 females, mean age 40.6 ± 10.0 years, range 19-60 years） were included. The mean 1SP score was 4.9 ± 1.7 （range 2-9 out of 10） at the time of recruitment and 5.1 ± 2.1 （range 2-9 out of 10） 7 days later. The percentage agreement between the two repeat measures of the ISP was 86% and the kappa coefficient was 0.79. Conclusion： This study suggests that the test-retest repeatability for the ISP is high and that it is thus likely to have a low risk of classification bias in prognostic studies. The ISP likely has adequate reliability for use in epidemiological research of WADs.

Development of a symptom expectation questionnaire for whiplash injury

Background:Expectations and beliefs appear to be important predictors of outcome following whiplash injury.Instruments for measuring these expectations in the general population have not been well studied.The objective of this study was to develop a simple symptom expectation questionnaire for whiplash injury for use in future research studies. Methods:An existing database of 179 injury-naive subjects who completed a 56-item checklist of expected symptoms for whiplash injury was analyzed to determine which items could correctly identify an a priori case definition of an expecter(a subject who expected at least one of these symptoms would remain chronic following whiplash injury).A total of seven of the 56 items were found to be discriminatory.The identified, discriminatory items were then tested in additional subject groups against the original questionnaire. Results:From the original database of 179 subjects completing a 56-item symptom expectation checklist,119 expected at least one of the 56 symptoms would be chronic following whiplash injury.The 119 expecters.however,all chose at least one of seven items:headache,anxious or worried,depressed,neck pain,problems sleeping,back pain,or jaw pain.Using these seven items,in two new groups of subjects given the 56- item symptom expectation checklist and then a new shortened(7-item) symptom expectation checklist one week later(and the same done for another group of 100 subjects in reverse order),all those who endorsed one of the 56 symptoms as likely to be chronic following whiplash injury (expecters) could also be identified on the 7-item checklist. Conclusion:A shortened(7-item) symptom expectation checklist of commonly reported symptoms following whiplash injury(headache, anxious or worried,depressed,neck pain,problems sleeping,back pain,and jaw pain) correctly identifies subjects who expect at least one symptom will be chronic following minor head injury(i.e.,an expecter).This shortened(7-item) symptom expectation checklist can be used in future population-based studies to understand the prevalence of belief patterns and expectations for whiplash injury.

Postmortem MSCT Diagnosis of Whiplash Injuries in a Traffic Accident：A Case Report and Review of the Literature

A 45-year-old male car driver died in a traffic accident of four cars rear-end collision on the highway.He was found to have died after a respiratory and cardiac arrest at the scene.No sign of skin injuries was observed from the external inspection.The autopsy was not permitted by the family members because of the local culture.Multislice computed tomography(MSCT)was applied to the current case,showing dislocation of C3~4cervical vertebrae withⅡdegree,C4vertebral plate fractures,and spinal stenosis.Post-mortem MSCT confirmed the diagnosis as whiplash injuries.MSCT was verified to be effective in showing the severity of whiplash injuries,thus providing certain objective evidence for medicolegal expertise.

New Concept of Whiplash Injuries Rehabilitation

Whiplash injuries are a global health problem and a significant financial burden for both health care systems,and insurance providers.The diverse symptomatology after whiplash injury both in the somatic,emotional and behavioral sphere prompted separation of the Whiplash Associated Disorders(WAD)as a separate category of diseases.The exact mechanism of whiplash injury is still under debate and theories explaining pathogenesis of WAD are very diverse ranging from purely biomechanical to neurophysiological,emphasizing central sensitization but the core disability seems to be strictly connected to somatosensory dysfunction.As a result,the optimal algorithm of rehabilitation has not been established and data published in the current literature on effectiveness of such algorithms are inconsistent.Based on the presented here of Head Neutral Reference Point(HNRP),the objective of central desensitization is to restore valid somatosensory output from Cranio-cervical Junction(CCJ).This new concept of rehabilitation after whiplash presented here is based on clinical observations and is supported by initial results.

Altered thermal sensitivity in facial skin in chronic whiplash-associated disorders

There is a close functional relationship between the jaw and neck regions and it has been suggested that trigeminal sensory impairment can follow whiplash injury.Inclusion of manageable routines for valid assessment of the facial sensory capacity is thus needed for comprehensive evaluations of patients exposed to such trauma.The present study investigated facial thermal thresholds in patients with chronic whiplash-associated disorders（WADs）with both a qualitative method and quantitative sensory testing（QST）.Ten women with pain and dysfunction following a whiplash injury were compared to 10 healthy age-matched women.Thermal detection thresholds were assessed by qualitative chair-side testing and by QST according to the method-of-limits.Seven test sites in the facial skin（overlying each trigeminal branch bilaterally,and the midpoint of the chin）were examined.The detection warm and cold thresholds were defined as the mean values of 10 individual thresholds.For the WAD patients,the qualitative assessment demonstrated both reduced and increased sensitivity compared to the healthy,whereas QST systematically showed significantly higher detection thresholds（i.e.,decreased sensitivity）for both cold and warm stimuli.For the individuals who were assessed as having increased sensitivity in the qualitative assessment,the QST displayed either normal or higher thresholds,i.e.,decreased sensitivity.The results suggest that QST is more sensitive for detecting thermal sensory disturbances in the face than a qualitative method.The impaired thermal sensitivity among the patients corroborates the notion of altered thermal detection capacity induced by WAD-related pain.

Correlation between self-reported recovery and central sensitization in whiplash patients

Central sensitization has been associated with chronic pain in whiplash patients.Methods:Consecutive whiplash patients were assessed at 3 months post-whiplash injury with the brachial plexus provocation test(BPPT)as a sign of central sensitization.Self-reported recovery was assessed by the response to the question ‘Do you feel you have recovered fully from your accident injuries?'Results:Sixty-nine subjects(32 males,37 females,age 37.5±13.0 years(mean±SD),range 18-71)were included.Of these,34 reported a lack of recovery,and 35 reported recovery at 3 months post-injury.The mean BPPT elbow extension(from 180°)was 41.5±23.0°,and the mean VAS score for the BPPT was 2.2 ± 1.2(out of 10).Those who reported recovery had a mean BPPT elbow extension angle of 25.1±15.8 while those who did not report recovery had a mean BPPT angle of 58.4 ± 15.9(P＜0.05).The visual analogue scale(VAS)score for recovered subjects was 1.8 ± 1.1 and 2.7 ± 1.1(P＜0.05)for non-recovered.There was a moderate correlation between self-reported recovery and BPPT elbow extension angle(-0.44)and a lower correlation between self-reported recovery and VAS score(-0.30).Conclusion:Self-reported recovery correlates well with a lower likelihood of signs of central sensitization.Copyright(c)2012,Shanghai University of Sport.Production and hosting by Elsevier B.V.All rights reserved.

某座椅鞭打试验仿真与优化

针对某款座椅在鞭打试验中假人挥鞭伤较为严重,鞭打得分较低的问题,利用HyperMesh软件建立座椅有限元模型,并进行鞭打仿真分析,得到对鞭打伤害影响较大的因素分别为调角器刚度系数、头枕杆直径、靠背左侧支撑板厚度、靠背右侧支撑板厚度、靠背后部支撑板厚度、座垫右侧支撑板厚度和座垫左侧支撑板厚度,利用哈默斯雷试验设计方法对上述7个设计变量进行样本点采集,并利用移动最小二乘法进行近似模型拟合,采用全局响应面法对近似模型进行多目标优化,验证结果表明,优化模型的精度满足要求,优化后鞭打得分提高,座椅抗挥鞭伤性能显著提升。

基于文献计量学分析挥鞭样损伤的研究热点及趋势

目的 基于文献计量学分析挥鞭样损伤(WI)的研究热点及趋势。方法 检索Web of Science^(TM) Core Collection数据库,检索时限为1999年1月1日至2022年12月31日,搜集WI的相关文献,采用CiteSpace6.1.R6软件分析年度发文量变化趋势、国家/地区发文量、研究机构发文量、作者发文量,并进行关键词共现分析、关键词聚类分析、关键词突现分析。结果 1999—2022年Web of Science^(TM) Core Collection数据库收录的WI相关文献共2 790篇,年度发文量总体呈现波动上升的趋势。发文量排名前三的国家为美国、澳大利亚、加拿大。发文量排名前三的研究机构是昆士兰大学、阿尔伯塔大学、悉尼大学。发文量排名前三的作者为Sterling M、Cote P、Nijs J。关键词共349个,出现频次最高的关键词是颈痛、挥鞭样损伤、损伤。关键词可形成8个聚类,分别为颈痛、颈椎、本体感觉、挥鞭样损伤、恢复、效度、中枢敏化、核磁共振。生活质量、慢性挥鞭伤、创伤性脑损伤、中/重度残疾、心理测量特性、震荡等为WI研究领域未来的研究趋势。结论 WI研究热度总体呈现波动上升趋势,研究热点集中于颈痛、挥鞭样损伤、本体感觉、中枢敏化、核磁共振成像等方面,改善患者生活质量、关注患者心理状态、促进慢性WI患者康复、尽早识别合并颅脑损伤的WI患者或将是该领域未来的研究趋势。

基于鞭打性能的座椅靠背型面优化方法

为降低追尾时的挥鞭伤危害,提出一种座椅靠背型面优化方法,论述该方法对头后间隙的影响机制。基于该方法对某款座椅的鞭打性能进行优化,根据CNCAP规程进行试验验证。结果表明:该方法对座椅造型的影响程度较小,优化目标与试验结果吻合较好,假人颈部伤害值降低16.6%,上颈部载荷与下颈部载荷显著降低。

追尾碰撞颈部挥鞭伤害的试验研究

论述了低速追尾颈部伤害的损伤机理,并对比分析了国内外主要鞭打试验方法在波形、评价指标及评价方法上的异同。基于某款车型座椅进行了追尾碰撞鞭打试验,利用仿真软件分析了座椅特征参数对座椅颈部伤害指标的影响。通过降低头后间隙对该座椅进行了优化改进,结果表明,降低头后间隙后挥鞭伤害峰值呈减少趋势,有效提高了低速追尾乘员颈部保护性能。

防挥鞭伤安全座椅的初步研究

以Euro NCAP挥鞭伤动态评估为基础,采用DOE分析手段,得到座椅部分设计参数对挥鞭伤的影响规律。结果表明,随着座椅设计参数的变化,几个损伤评价指标呈非线性变化,而且是互相影响此消彼长。因此,防挥鞭伤安全座椅设计应是一种多目标综合优化设计。

基于挥鞭样损伤研究的颈部有限元模型的建立及验证

研究人体颈部在挥鞭样损伤中的生物力学特性及损伤机制,建立一个基于人体解剖学结构的颈部三维有限元模型。该模型是通过人体颈部的螺旋CT扫描图像,利用三维重建和网格划分技术,得到六面体有限元模型,并对模型进行后碰撞验证分析。得出颈椎在挥鞭运动过程中的变化规律,以及C7-T1的最大过伸角度20°和椎间盘所受最大应力值16MPa。该模型的建立,可作为今后颈椎生物力学损伤研究以及其他相关领域研究的理论研究依据。

基于假人头部受力分析的鞭打试验研究

通过对追尾碰撞中乘员运动情况和颈部损伤机理进行分析,结合鞭打试验中假人头部加速度与颈部受力间的关系,探讨了假人头部受力的分析方法,并就头部与头枕接触时刻、碰撞强度在座椅和头枕改善中的应用进行了研究。研究结果表明,接触时刻越早越有利于降低颈部NIC指标及头部碰撞强度;头部碰撞强度低、z向受力向下将有利于降低颈部各载荷。

基于台车试验的不同国家鞭打试验评价体系的相关性

汽车低速后碰是一种常见的交通事故。为防止该事故中乘员颈部挥鞭伤,各国都在促进被动安全技术的发展。该文对比了中国、欧洲、日本和美国不同鞭打试验程序在试验方法、评分方法和评分体系的差异。2012新版中国新车评价规程(C-NCAP)将鞭打试验纳入评价体系,它不同于欧洲新车评价规程(Euro-NCAP)、日本新车评价规程(J-NCAP)和美国公路安全保险协会(IIHS)的规程。用上述各评价体系和评分方法,对同一组试验数据进行评分,把评分结果进行3分制转换,然后进行分析。结果表明:上述各评价体系虽然有差异,但评价结果具有高度的一致性。C-NCAP评价得分高于其他体系评价得分。

基于仿真分析的某座椅鞭打性能改进

针对某车辆座椅在C-NCAP鞭打试验中颈部保护性能较差的问题,通过对人体头、颈部受力分析确定了改进方向,主要集中在座椅靠背刚度、头枕刚度和头后间隙等方面。建立了该座椅的鞭打仿真模型并进行了验证。基于该仿真模型对改进方案进行验证表明,改进方案可行。进行了改进座椅样件试制,其座椅鞭打试验结果验证了方案的有效性。

基于LS-DYNA的某座椅鞭打性能分析和优化

根据C-NCAP(2015版)鞭打试验评价规程和评分原则,利用BioRID II假人模型研究某座椅鞭打试验对于驾驶员颈部的伤害。利用动态非线性显式有限元方法,以动力学分析软件LS-Dyna为求解器,按照C-NCAP鞭打试验的要求建立有限元模型,实现鞭打试验的仿真和优化。研究结果表明:更改头枕杆的结构,使头部与头枕的间距和高度缩小,可以显著减小鞭打试验中颈部的损伤程度,从而实现座椅的有效优化。

挥鞭样仿真全颈椎有限元模型的建立和验证

目的建立并验证中国人全颈椎有限元模型,以期用于挥鞭样损伤分析。方法运用螺旋CT扫描技术、Ma-terialisc mimics、逆向软件及Pro-E进行三维重建;运用TrueGrid划分网格;模型用志愿者后碰撞(挥鞭)试验数据进行验证。结果模型由椎骨、椎间盘、小关节、韧带和肌肉等结构组成,共得到15023个单元和24916个节点,其中实体单元14626个、杆单元19个、索单元378个。仿真中得到的头颈部加速度、位移、旋转角度、角加速度等运动曲线和实验结果基本吻合。结论模型高质量的八节点六面体单元,提高了计算的速度和稳定性。模型用于挥鞭样损伤分析,对于预防、诊断、治疗具有重要意义。

兔追尾交通伤的实验研究

目的探讨汽车追尾碰撞交通伤的伤情特点。方法15只家兔随机平均分为3组,胸、腹部以医用绷带固定后,分别以30km/h(Ⅰ组)、40km/h(Ⅱ组)、45km/h(Ⅲ组)进行汽车追尾碰撞,高速摄像与激光测速记录碰撞全过程,用运动软件分析碰撞加速度,观察动物损伤情况。结果3组动物沿绷带走行方向均有皮下轻度出血,Ⅰ组未发现脏器损伤;Ⅱ组肺、肝脏损伤分别为1例和2例;Ⅲ组颅脑损伤1例,肺损伤4例。结论动物的损伤情况与其固定方式以及汽车追尾碰撞速度、加速度有关,汽车追尾碰撞交通伤的伤情规律研究应进一步加强。

颈椎过伸性损伤机制与病理改变的研究进展

颈椎过伸性损伤又称颈椎挥鞭样损伤,其常见于汽车追尾时突然减速致头面部的撞击伤、额面部着地的高处坠落伤以及汽车突然加速产生的惯性导致的颈椎挥鞭样损伤,在发育性颈椎椎管狭窄或颈椎退变明显的老年人中较为常见[1-2]。1954年Schneider等[3]结合临床病例并进行尸体解剖,首次阐述了颈椎过伸性损伤机制,此后颈椎过伸性损伤开始受到重视,相关文献报道日益增多[4-7]。由于不同的受伤原因,脊髓内部受损程度不一,

中青年无骨折脱位型颈髓挥鞭伤的临床治疗研究

目的探讨中青年无骨折脱位型颈髓挥鞭伤的临床治疗策略及疗效。方法：收治38例此类患者，根据患者脊髓损伤情况及影像学表现将患者分为四型，并根据不同类型选择不同的治疗方式。I型行保守治疗；II型行后路颈椎管扩大成形术；III型行颈前路减压、椎间植骨融合内固定术；1V型行颈后路单开门椎管扩大成形术＋颈前路减压植骨内固定术。结果：术后随访14—32个月，平均22个月。所有患者出院与入院时比较，ASIA分级提高，具有统计学意义（P〈0．05）；出院时、伤后3个月、伤后6个月JOA评分分别与入院时相比提高，具有统计学意义（P〈0．05）。结论：对于中青年无骨折脱位型颈脊髓挥鞭伤患者来说，结合患者脊髓损伤情况及影像学表现分型，选择不同治疗方案，均使患者脊髓功能得到了恢复，预后良好，值得临床推广应用。