Epidemiology and characteristics of complicated injuries in patients with spinal fractures as a result of catatrauma

The study objective is to identify the features of diagnosis of patients with spinal cord injuries, resulting from falls from a height.

Materials and methods. The data from 148 patients who were treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine in the period from 01.01.2011 to 04.01.2016 were analyzed. Of these, 98 patients (the studied group) were injured in the spinal column as a result of a fall from a height of more than 2 m, 50 people (the comparison group) suffered in traffic accidents. We used clinical data, laboratory and radiological diagnostic methods. The severity of injuries in spinal injury was assessed according to the Injury Severity Score. When assessing the neurological status in spinal patients, the ASIA (American Spine Injury Assosiation) scale was used.

Results. Significant differences in age (p = 0.57) and sex (p = 0.24) in the groups were not observed. More often at night: in the period from 00:00 to 6:00 in the morning – 44 (44.9 %) patients. There were significantly more patients with combined spinal injury in the studied group – 60 (61.2 %) than in the comparison group – 24 (48 %) (p <0.05). The assessment of the severity of the patients showed that the proportion of victims with severe neurological disorders (ASIA A) in the studied group was 30.6 % (30 victims), while in the comparison group the number of such patients was significantly lower – 3 (6.0 %) patients (p <0.05). The average score on the Injury Severity scale in the studied group was 25.7 ± 5.5, in the comparison group – 26.3 ± 6.1. There were no significant intergroup differences in this indicator.

Conclusion. Spinal cord injuries in catatrauma in 61.2 % of patients were accompanied by combined injuries of the internal organs and the musculoskeletal system. In 25.5 % of patients with catatrauma craniocerebral lesions were detected. On the ASIA scale, the proportion of victims with the most pronounced neurological disorders (ASIA A) was 30.6 %, and in the event of an accident – 6.0 %; to ASIA E – 36.8 % (in case of an accident – 64.0 %).

1. Гринь А.А., Некрасов М.А., Кайков А.К. и др. Алгоритмы диагностики и лечения пациентов с сочетанной позвоночно-спинномозговой травмой. Хирургия позвоночника 2012;(1):8–18. [Grin A.A., Nekrasov M.A., Kaikov A.K. et al. Algorithms for diagnosis and treatment of patients with concomitant spine and spinal cord injury. Khirurgiya pozvonochnika = Spine Surgery 2012;(1):8–18. (In Russ.)].

2. Шкарупа А.В. Диагностические аспекты травмы, полученной в результате падения с высоты. Дис. ... канд. мед. наук. Саратов, 2006. 136 с. [Shkarupa A.V. Diagnostic aspects of injuries received in a fall from a height. Dis. … of cand. of med. sciences. Saratov, 2006. 136 p. (In Russ.)].

3. Vasudera Murthy S.R., Harish S., Girish Chandra Y.P. The study of pattern of injuries in fatal cases of fall from height. AJMS Al Ameen J Med Sci 2012;5(1):45–52.

4. Ардашев И.П., Григорук A.А., Плотников Г.А. и др. Повреждения позвоночника при кататравме. В сб.: Диагностика и лечение политравм: материалы всерос. науч.-практ. конф. Ленинск-Кузнецкий, 1999. С. 173–174. [Ardashev I.P., Grigoruk A.A., Plotnikov G.A. et al. Spinal injuries in catatrauma. In: Diagnosis and treatment of polytrauma: proceedings of the all-Russian scientific conference. Leninsk-Kuznetsky, 1999. Pp. 173–174. (In Russ.)].

5. Хаджибаев А.М., Султанов П.К., Рахманов Р.О. Использование современных диагностических и лечебных технологий при повреждениях груди вследствие кататравмы в Республиканском научном центре экстренной медицинской помощи. Журнал им. Н.В. Склифосовского «Неотложная медицинская помощь» 2015;(4):44–50. [Khadzhibayev A.M., Sultanov P.K., Rakhmanov R.O. Modern diagnostic and therapeutic technologies for the chest trauma associated with the fall from a height in the Republic Research Centre of Emergency Medicine. Zhurnal im. N.V. Sklifosovskogo “Neotlozhnaya meditsinskaya pomoshch” = The Russian Sklifosovsky Journal “Emergency Medical Care” 2015;(4):44–50. (In Russ.)].

6. Gulati D., Aggarwal A.N., Kumar S., Agarwal A. Skeletal injuries following unintentional fall from height. Ulus Travma Acil Cerrahi Derg 2012;18(2):141–6.

7. Басков А.В., Борщенко И.А. Техника и принципы хирургического лечения заболеваний и повреждений позвоночника. Практическое руководство. М.: Гэотар-медиа, 2008. 131 с. [Baskov A.V., Borshchenko I.A. Technique and principles of surgical treatment of diseases and injuries of the spine. Practical guide. Moscow: Geotar-media, 2012. 131 p. (In Russ.)]. 8. Isbister E.S., Roberts J.A. Autokabalesis: a study of intentional vertical deceleration injuries. Injury 1992;23(2):119–22.

8. Кайков А.К. Ошибки и их профилактика в диагностике и лечении больных с травмой позвоночника и спинного мозга. Дис. … канд. мед. наук. М., 2013. 132 с. [Kaykov A.K. Mistakes and their prevention in the diagnosis and treatment of patients with the spine and spinal cord injury. Dis. … of cand. of med. sciences. Moscow, 2013. 132 p. (In Russ.)].

9. Луцик А.А., Бондаренко Г.Ю., Булгаков В.Н., Епифанцев А.Г. Передние декомпрессивно-стабилизирующие операции при осложненной травме грудного и поясничного отделов позвоночника. Хирургия позвоночника 2012;(3):8–16. [Lutsik A.A., Bondarenko G.Yu., Bulgakov V.N., Epifantsev A.G. Anterior decompressive stabilizing operations in complicated trauma of the thoracic and lumbar spine regions. Khirurgiya pozvonochnika = Spine Surgery 2012;(3):8–16. (In Russ.)].

10. Авдеев М.И. Повреждения от падения с высоты. В кн.: Авдеев М.И. Курс судебной медицины. М.: Госюриздат, 1959. С. 129–133. [Avdeev M.I. Injuries from a fall from a height. In: Avdeev M.I. Course of forensic medicine. Moscow: Gosyurizdat, 1959. Pp. 129–133. (In Russ.)].

11. Горохова Е.Н. Диагностика и хирургическое лечение множественных повреждений шейного отдела позвоночника дегенеративно-дистрофического и травматического генеза. Дис. ... канд. мед. наук. М., 2008. 175 с. [Gorokhova E.N. Diagnosis and surgical treatment of multiple lesions of the cervical spine region of degenerative dystrophic and traumatic genesis. Dis. … of cand. of med. sciences. Moscow, 2008. 175 p. (In Russ.)].

12. Saito F., Nakatani T., Iwase M. et al. Administration of cultured autologous bone marrow stromal cells into cerebrospinal fluid in spinal injury patients: a pilot study. Restor Neurol Neurosci 2012;30(2):127–36. DOI: 10.3233/RNN-2011-0629.

13. Rowbotham S.K., Blau S. Skeletal fractures resulting from fatal falls: a review of the literature. Forensic Sci Int 2016;266:582.e1–15. DOI: 10.1016/j.forsciint.2016.04.037.

14. Валеев К.Е. Совершенствование тактики лечения повреждений нижнегрудного, поясничного отделов позвоночника в сочетании с переломами костей нижних конечностей. Дис. ... канд. мед. наук. Н. Новгород, 2004. 104 с. [Valeev K.E. The tactics improving of treatment of injuries of the lower thoracic, lumbar spine regions in combination with fractures of the bones of the lower limbs. Dis. … of cand. of med. sciences. Nizhny Novgorod, 2004. 104 p. (In Russ.)].

15. Селиверстов П.А., Шапкин Ю.Г., Акрамов И.Э. Анализ структуры сочетанной и множественной травмы опорно-двигательного аппарата. Бюллетень медицинских интернетконференций 2013;(8):1053. [Seliverstov P.A., Shapkin Yu.G., Akramov I.E. Analysis of the structure of concomitant and multiple injuries of the locomotor apparatus. Bulleten meditsinskikh internet-conferentsiy = Bulletin of Medical Internet Conferences 2013;(8):1053. (In Russ.)].