Experimental Study on Neck Injury in Low Speed Frontal and Rear-End Collisions

Kim, Gyu-Hyun,Lee, Ouk-Sub,Hwang, Si-Won The Korean Society of Mechanical Engineers 2000 JOURNAL OF MECHANICAL SCIENCE AND TECHNOLOGY Vol.14 No.11

Motor vehicle accidents in rear impacts cause more than fifty percents of drivers to suffer from neck injuries. It is known that most neck injuries are associated with rear-end collisions at a speed lower than 32 km/h and between the Abbreviated Injury Scale (AIS) 1 and AIS 2. Two different types of low speed crash tests such as the frontal barrier and rear moving barrier crashes have been conducted by following the procedure of the Research Committee for Automobile Repairs (RCAR). The injury for the neck and the Head Injury Criteria (HIC) were measured by using the sensors mounted on dummies. We reviewed neck injures and the relationship between the neck and head injuries, and examined the deceleration of the body. Using the experimental test data at the neck, we investigated an improved neck injury criterion Nij. Also, the effects of the position of a head restraint on reducing the frequency and severity of the neck injury in rear-end collisions were investigated.

관통성 경부 손상에 관한 임상적 고찰

최환,홍석진,김연수,조재구,백승국,우정수,정광윤,권순영,Choe, Hwan,Hong, Seok-Jin,Kim, Yeon-Soo,Cho, Jae-Gu,Baek, Seung-Kuk,Woo, Jeong-Soo,Jung, Kwang-Yoon,Kwon, Soon-Young 대한기관식도과학회 2010 大韓氣管食道科學會誌 Vol.16 No.2

Background: Penetrating neck injuries are potentially dangerous and require emergency management because of the presence of vital structures in the neck. The risk of airway, vascular, neurological, and pharyngoesophageal injuries leads to many difficult diagnostic decisions. The purpose of this retrospective study is to evaluate our experience with management of penetrating neck injuries, and to assess treatment outcome. Material and Method: Forty-two consecutive patients were identified (26 patients from Korea university Ansan hospital, 16 patients from Guro hospital) as having penetrating neck injuries from 2003 to 2009. With review of medical records, variables were collected and evaluated including the location of injury, mechanism of injury, number of significant injuries, diagnostic modalities, duration of hospital stay and outcome. Results: The location of injury was zone I (lower neck) in 13 cases (31%), zone II (midportion of the neck) in 22 (52%), and zone III (upper neck) in 7 (17%). Injuries were caused by stab wounds in 23 patients, penetrating foreign bodies in 12. Among 35 patients who had deep injuries that violated the platysma, significant injuries, including major vascular (20), trachea (5) Pharyngoesophageal injuries (5) were identified in 24 patients. The mean hospital stay was 9.5 days. Conclusion: The penetrating trauma in the neck may show various degrees of severity. However, Cervical penetrating injury should not be underestimated in spite of the minimal width of the lesion.

복부와 경부 관통상 환자에 대한 임상적 고찰

노하니 ( Ha Ny Noh ),김광민 ( Kwang Min Kim ),박준범 ( Joon Beom Park ),류훈 ( Hoon Ryu ),배금석 ( Keum Seok Bae ),강성준 ( Seong Joon Kang ) 대한외상학회 2010 大韓外傷學會誌 Vol.23 No.2

Purpose: Recently, the change to a more complex social structure has led to an increased frequency of traumas due to violence, accident and so on. In addition, the severity of the traumas and the frequency of penetrating injuries have also increased. Traumas to cervical and abdominal areas, what are commonly seen by general surgeons, can have mild to fatal consequences because in these areas, various organs that are vital to sustaining life are located. The exact location and characteristics of the injury are vital to treating patients with the trauma to these areas. Thus, with this background in mind, we studied, compared, and analyzed clinical manifestations of patients who were admitted to Wonju Christian hospital for penetrating injuries inflicted by themselves or others. Methods: We selected and performed a retrospective study of 64 patients who had been admitted to Wonju Christian Hospital from January 2005 to December 2009 and who had cervical or abdominal penetrating injuries clearly inflicted by themselves or others. Results: There were 51 male (79.7%) and 13 female (20.3%) patients, and the number of male patients was more dominant in this study, having a sex ratio of 3.9 to 1. The range of ages was between 20 and 86 years, and mean age was 43.2 years. There were 5 self-inflicted cervical injuries, and 19 self-inflicted abdominal injuries, making the total number of self-inflicted injury 24. Cervical and abdominal injuries caused by others were found in 11 and 29 patients, respectively. The most common area involved in self-inflicted injuries to the abdomen was the epigastric area, nine cases, and the right-side zone II was the most commonly involved area. On the other hand, in injuries inflicted by others, the left upper quadrant of the abdomen was the most common site of the injury, 14 cases. In the neck, the left-side zone II was the most injured site. In cases of self-inflicted neck injury, jugular vein damage and cervical muscle damage without deep organ injury were observed in two cases each, making them the most common. In cases with abdominal injuries, seven cases had limited abdominal wall injury, making it the most common injury. The most common deep organ injury was small bowel wounds, five cases. In patients with injuries caused by others, six had cervical muscle damage, making it the most common injury found in that area. In the abdomen, small bowel injury was found to be the most common injury, being evidenced in 13 cases. In self-inflicted injuries, a statistical analysis discovered that the total duration of admission and the number of patients admitted to the intensive care unit were significantly shorter and smaller, retrospectively, than in the patient group that had injuries caused by others. No statistically significant difference was found when the injury sequels were compared between the self-inflicted-injury and the injury-inflicted-by-others groups. Conclusion: This study revealed that, in self-inflicted abdominal injuries, injuries limited to the abdominal wall were found to be the most common, and in injuries to the cervical area inflicted by others, injuries restricted to the cervical muscle were found to be the most common. As a whole, the total duration of admission and the ICU admission time were significantly shorter in cases of self-inflicted injury. Especially, in cases of self inflicted injuries, abdominal injuries generally had a limited degree of injury. Thus, in our consideration, accurate injury assessment and an ideal treatment plan are necessary to treat these patients, and minimally invasive equipment, such as laparoscope, should be used. Also, further studies that persistently utilize aggressive surgical observations, such as abdominal ultrasound and computed tomography, for patients with penetrating injuries are needed. (J Korean Soc Traumatol 2010;23:107-112)

The Neck and Posterior Fossa Combined Penetrating Injury: A Case Report

한현진,정준호,홍창기,김용배 대한신경손상학회 2016 Korean Journal of Neurotrauma Vol.12 No.2

Here we report a case of penetrating neck injury to the posterior fossa that was shown, using high-resolution computed tomography (HRCT) and digital subtraction angiography (DSA), to involve no vascular injury. A 54-year-old man was brought to the emergency department after a penetrating injury to the left side of the posterior neck and occipital area with a knife. He was in an intoxicated state and could not communicate readily. On initial examination, his vital signs were stable and there was no active bleeding from the penetrating site. Because of concern about possible injury to adjacent vessels, we performed HRCT and DSA sequentially, and identified that the blade of the knife had just missed the arteriovenous structures in the neck and posterior fossa. The patient was then transferred to the operating room where the knife was gently removed. Further careful exploration was performed through the penetrating wound, and we confirmed that there were no major injuries to the vessels and neural structures. Postoperative computed tomography revealed that there was minimal hemorrhage in the left cerebellar hemisphere. The patient made a full recovery without any neurologic deficit. In this case, HRCT is a suitable tool for the initial overall evaluation. For the evaluation of vascular injury, DSA can be a specific and accurate tool. Mandatory exploration widely used for penetrating injuries. After careful preoperative evaluation and interpretation, simple withdrawal of material can be a choice of treatment.

제초기 칼날에 의한 경동맥 관통상 1예

강기근,이동근,박헌수,홍종철 대한이비인후과학회 2012 대한이비인후과학회지 두경부외과학 Vol.55 No.3

There are many vital structures in the neck, but they are not protected by bone. The neck is vulnerable to injury, and difficult to evaluate the extent of injury. Especially, penetrating neck wounds are potentially dangerous and require emergency treatment. A 56-year-old man with a penetrating neck injury by a grass cutter fragment was transferred from another hospital. There were no immediate life-threatening signs or symptoms. Carotid artery injury was suspected in the computed tomography scan. Emergent exploration was implemented by vascular surgery to remove the grass cutter fragment that had penetrated the left common carotid artery. We report a rare case of common carotid artery penetrating injury that was treated without any complications.

The efficacy of the “no zone” approach for the assessment of traumatic neck injury: a case-control study

Ji Wool Ko,Seong Chan Gong,Myung Jun Kim,Jae Sik Chung,Young Un Choi,Jun Hyuk Lee,Pil Young Jung 대한외과학회 2020 Annals of Surgical Treatment and Research(ASRT) Vol.99 No.6

Purpose: Recently, several studies have demonstrated symptom-based, non-zonal algorithms for approaching penetrating neck injuries. The purpose of this study was to confirm the effectiveness of the “no zone” approach in traumatic neck injuries. Methods: Medical charts of patients with traumatic neck injuries who presented at the Regional Trauma Center in South Korea between January 2014 and December 2018 were retrospectively reviewed. Negative final neck findings (FNFs) were compared with positive FNFs (which include major vascular, aerodigestive, nerve, endocrine gland, cartilage, or hyoid bone injuries) using multivariate logistic regression analysis including values of the “zone” and/or no zone approach. Results: Out of 168 trauma patients, 70 patients with a minor injury and 7 patients under the age of 18 years were excluded. Of the remaining 91 patients, 74 (81.3%) had penetrating neck injuries and 17 (18.7%) had blunt neck injuries. Initial diagnosis most frequently revealed external wounds in zone II (84.6%). Twenty (22.0%) and 36 (39.5%) patients had hard and soft signs, respectively, using the no zone approach. Further, there was a significant difference between the negative and positive FNFs in patients with hard signs (11.6% vs. 54.5%; P < 0.01, respectively). According to the multivariate logistic regression analysis, the hard signs were associated with an odds ratio (OR) for FNFs (OR, 18.92; 95% confidence interval, 3.55–157.60). Conclusion: Traumatic neck injuries classified as having hard signs based on the no zone approach may be correlated with internal organ injuries of the neck.

경부 관통상 환자에서 표재성 손상과 심부 손상을 구별할 수 있는 임상 예측 인자

정우한,최경호,오영민,최세민,오주석,박정택,이두효,김기욱,홍성엽,정현호 대한응급의학회 2022 대한응급의학회지 Vol.32 No.6

Objective: The frequency of penetrating neck injuries has gradually increased with the development of industry and the rising crime rates. There have been few studies with penetrating neck injuries reported in Korea. Thus, we analyzed clinical factors that could differentiate between superficial and deep injuries in patients with penetrating neck injuries. Methods: We investigated the medical records of 90 patients with penetrating neck injuries who visited the emergency department between January 2010 and March 2020. To identify the degree of injuries, we compared age, sex, onset and arrival time, onset-to-arrival time, initial vital signs, Glasgow Coma Scale, Revised Trauma Score, cause, mechanism, location and number of injuries, anatomical zone, alcohol intake and psychiatric history were classified as early clinical factors. Results: Among 90 patients, 51 had superficial injuries, and 39 had deep injuries. The early clinical factors showing statistically significant differences were the Glasgow Coma Scale, Revised Trauma Score, cause of injury and anatomical zones. As the Glasgow Coma Scale increased by 1 point, deep injuries decreased by 0.807 times compared to superficial injuries. Homicidal injuries were 3.233 times deeper than suicidal injuries. Conclusion: If the Glasgow Coma Scale is low or the cause of injury is homicide, the possibility of a deep penetrating injury is high. Therefore, it is important to treat the patient carefully, considering these factors.

편타성 손상으로 인한 경항통 환자를 대상으로 한 일반침 치료와 간접구 병행치료의 임상적 효과비교연구

김민석,박재연,최유진,윤경진,이참결,이은용,노정두 대한침구의학회 2011 대한침구의학회지 Vol.28 No.6

Objectives : The purpose of this study was to evaluate the clinical effect of indirect moxibustion treatment for patients with neck pain caused by whiplash injury. Methods : From October 2010 to October 2011, 85 patients with neck pain caused by whiplash injury who admitted to Semyung oriental medical hospital were divided into two groups. Group A was treated by general acupuncture, group B by indirect moxibustion and general acupuncture. The efficacy of treatment was measured by visual analog scale(VAS) scores and neck disability index(NDI) scores of before and after 5 days to start treatment. Results : 1. Both group A and B represented effective improvement in VAS and NDI of neck pain caused by whiplash injury. 2. Group B has more statistical effect than group A. Conclusions : Through this research, indirect moxibustion treatment is considered to be effective reducing pain for patients with neck pain caused by whiplash injury.

Analysis of Neck Trauma Patients Using the Korean National Emergency Department Information System

Jung Hun Kim,Sung Won Jung,Jin Suk Lee,Jong-Min Park,Han Deok Yoon,Jung Tak Rhee,김선월,Borami Lim,So Ra Kim,Il-Young Jung 대한외상중환자외과학회 2018 Journal of Acute Care Surgery Vol.8 No.1

Purpose: Trauma is a leading cause of death, even in previously healthy and disease-free individuals, and the mortality rate is very high in neck trauma patients. On the other hand, there have been few studies related to neck injuries. This study examined the characteristics and treatment results of trauma-related neck injuries using the data from Korean National Emergency Department Information System. Methods: Neck trauma patients were classified using the 6th Korean Standard Disease Classification system. The patients’ demographic factors, number of surgeries, and clinical results were investigated. Statistical analysis was conducted using SPSS to evaluate the annual differences in the demographic factors; mortality according to the site of injury and type of surgery; and mechanisms of injury. Results: From 2011 to 2014, 2,458 neck trauma patients were treated in hospitals in South Korea. The number of patients admitted to regional and local emergency medical centers was 883 (35.9%) and 1,502 (61.1%), respectively. No significant annual differences were observed in age, sex ratio, location of treatment center, mortality, and injury site (vascular, tracheal, or esophageal). In addition, no significant differences in the cause of injury, performed surgery (%), and mortality according to the injured organ were observed. Conclusion: This study revealed no annual changes in neck injury patients or differences in mortality according to injured organs. This study can be used as a basis for national research on organ-specific injuries, and may help predict the demand for future support projects for the establishment of regional trauma centers. (J Acute Care Surg 2018;8:7-12)

A Study on the Influence of the Seat and Head Restraint Foam Stiffnesses on Neck Injury in Low Speed Offset Rear Impacts

Hui-Chang Jo,Young-Eun Kim 한국정밀공학회 2009 International Journal of Precision Engineering and Vol.10 No.2

Soft tissue neck injury (STNI) is thought to he related to automotive seat characteristics, and it is important to know how the stiffness of the seathack and head restraint foam affect the occupant's motions in low speed rear impacts. The comhined MADYMO(MAthematical DYnamic MOdel, TNO) 50th percentile facet male human body model with a detailed neck model was selected for this analysis. In order to determine the relationship between the occupant's motions and seatback and head restraint foam stiffnesses, 40% offset rear impact simulations were performed by changing the stiffiness of seatback and head restraint. Simulated results show that the maximum acceleration of head and trunk would tend to increase with those stiffnesses. Increased stiffness of the seatback and head restraint resulted in increased ligament and disc forces. On the other hand a proper combination of seatback and head restraint stiffness can reduce a possible neck injury. It is clear that an appropriate combination of stiffnesses between seatback and head restraint allows to minimize a neck injury.