摘要

The annual incidence of whiplash injuries ranges from 70 to 360 per 100,000 persons according to available epidemiologic research. The debate to define the pathophysiological and clinical features of conditions following whiplash injury (frequently called Whiplash-Associated Disorders — WAD) is ongoing.
The clinical spectrum of disorders following whiplash injury is wide: it includes localized symptoms such as neck pain and stiffness, headache, visual symptoms, and unlocalized disturbances such as dizziness, fatigue, and cognitive and psychic impairment. The evolution of WAD is differently reported, but almost 6 to 20% of subjects complain of some disturbance 1 year after neck trauma.
The lack of consensus regarding the clinical features, negative influences decisions regarding the treatment of whiplash symptoms are needed. Some evidence is now available on the role of the cervical zygapophysial joint and cervical disc rims in the persistence of neck pain, and that of psychic and cognitive impairment in long-term disability. The therapeutic approach may vary because of the many possible agents (modalities, drugs, and surgical procedures). A few clinical trials support the use of electromagnetic therapy and observations indicate the beneficial effect of discectomy with interbody fusion when cervical disc lesion and radicular involvement are diagnosed. A consensus regarding early active mobilization, symptom treatment, and repeated counseling has been reached by many clinicians.
The clinical approach to patients after a whiplash injury is conditioned both by the symptom occurrence and medical or social context, but a problem-oriented approach is encouraged in all cases. On this basis, clinical assessment may involve the osteoarticular, the soft tissues, the sensory organs, the nervous system, or the behavior, depending on the disorders.
Because of the different skills required both in the short- and in the long-term assistance of whiplash patients, a more detailed knowledge and the organization of specialized centers are to be encouraged.