Whiplash Associated Disorders: A Literature Review of Its Treatment, Outcome and Clinical Expectations

鞭索傷害的治療方法、效果和臨床期望的文獻回顧

何兆邦(Larry Ho) ； 蕭美璇(Stacey M. Siu)

《物理治療》 31卷2期 (2006/04) Pp. 118-129

摘要

目的：本文藉回顧1966-2004年間發表之相關文獻，探討鞭索傷害之治療方法、效果和臨床期望。方法：作者首先列舉物理治療臨床上最常遇到與鞭索傷害相關的問題，然後搜索文獻，選出相關文章，然後針對每個問題列舉有關答案，做成表格。結果與結論：(1)女性發生車禍時其鞭索傷害之發生率為60%。(2)25歲以上駕駛人之受傷機會為25歲以下者之1.5倍。(3)車禍受傷後治療時間為14-85天。(4)車禍受傷後之痛症可延伸20天至2年之久。(5)愈早回復平常的活動愈會有良好的結果。(6)車禍受傷前有脊柱病變對結果沒有影響。(7)沒有文獻證明車禍受傷會引起退化性病變。(8)損失賠償可以影響個案結案時間長短，但對治療效果和病症並無不良影響。(9)可以預測不良結果之原因有：甲、開始時有劇烈的疼痛。乙、有神經根病變。丙、有心理病變。丁、有神經機能障礙。

關鍵字

鞭索傷害 ； 治療效果 ； 頸椎

並列摘要

Objectives: 1) Provide demographic risk factors associated with Whiplash Associated Disorders (WAD); 2) Present the current evidence on WAD's treatments and outcomes; 3) Provide information to the healthcare & legal communities regarding the effect of potential compensation on outcomes and prognostic risk factors following WAD. Summary & Background: Outcome following Motor Vehicle Accident (MVA)-induced neck pain is influenced by a multitude of factors, ranging from the severity of the biomechanical insult to the variety of treatments available for the underlying and resultant physical and psychological pathology. Well-defined articles on WAD have been published in the last 10 years, expanding our current knowledge and understanding in this subject. However, many clinical questions related to physical therapy, treatment time, pain duration, pre-existing spinal conditions, and compensation still remain unanswered. The purpose of our paper was to present the current literature aimed at addressing these unanswered clinical questions. Methods: A literature search was performed on Ovid databases for articles published between 1966 and 2004. Two reviewers screened 48 articles and selected data related to the pre-set clinical questions. A table was developed to summarize and compare results from each article/paper. The quality of each paper selected for review was rated according to criteria set forth by ”Levels of Evidence and Grades of Recommendation”. The Results/Conclusions were based on a compilation of the current available external evidence. Results/Conclusion: 1) Sixty percent of involvement in MVA are females; 2) Drivers older than 25 years of age have a 1.5 times risk of cervical injury compared to those who are younger; 3) Treatment time ranges from 14-85 days following a MVA; 4) MVA-induced pain may last from 20 days to 2 years post-MVA; 5) Early resumption of pre-MVA activities result in improved outcomes; 6) Pre-existing spinal conditions do not influence outcomes following a MVA; 7) No strong evidence supports that MVA induces degenerative changes; 8) Compensation affects claim settlement duration but does not adversely influence prognosis or symptom resolution; and 9) Prognostic factors predicting a poor outcome; including a) higher initial pain intensity; b) presence of radicular symptoms; c) psychiatric morbidity; and d) presence of neurological deficits.

並列關鍵字

Whiplash associated disorders ； Outcomes ； Cervical spine