[使用和不使用刚性颈部矫形器在救护车上运送严重受伤的创伤患者:生物力学测量对比]。

Die Anaesthesiologie Pub Date : 2024-10-01 Epub Date: 2024-09-24 DOI:10.1007/s00101-024-01462-w
Martin Kieninger, Corinna Schneider, Simon Auer, Lukas Reinker, Ina Adler, Sebastian Dendorfer, Johanna Rosenberger, Daniel Popp, Christoph Eissnert, Dominik Ludsteck, Christopher Cyrus, Johannes Hoffmann, Sarah Morag, Bernhard Graf, Bärbel Kieninger
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引用次数: 0

摘要

背景:院前固定颈椎对严重创伤患者的实际意义尚不明确。鉴于可能存在的负面影响,例如使用硬质颈椎矫形器会导致颅内压升高,因此必须对长期使用颈椎矫形器提出严格质疑。要证明在院前环境中长期使用硬质颈椎矫形器的合理性,还需要进一步的研究:目的:在使用真空床垫固定颈椎时,在担架上定位后使用或不使用硬质颈椎矫形器,对颈椎的活动度进行了比较测量:在现代救护车的装卸过程中,以及在沿预定路线行进的过程中,通过将惯性测量装置安装在受测者身上,对颈椎的运动进行了生物力学测量。接受测量的测试人员被固定在真空床垫上,头部和下巴以及额头可选择横向固定在电动液压担架上。整个标准监测系统的设置是为了尽可能真实地模拟重伤患者的运送过程。总共进行了 30 次测试。在一半的测试中,额外使用了刚性矫形器固定颈椎,另一半测试中没有使用颈椎矫形器。在这 30 次测试中,每次都考虑了加载、运输和卸载时的角度、轴向旋转、侧弯和屈/伸以及一阶和二阶导数,并计算了每次测试的零位平均偏差、扫角范围大小和最大值等参数:结果:仅在矢状面(屈曲和伸展)的某些生物力学参数上发现了具有统计学意义的差异。其他运动方向(轴向旋转、侧屈)的测量参数没有发现明显差异。一般来说,在使用颈椎矫形器和不使用颈椎矫形器的测试中,都只测得很小的角度偏移(轴向旋转和屈/伸的平均偏移范围为1-2°,侧屈可达3°):结论:如果在带有加载系统的电动液压担架上正确使用真空床垫进行固定,并选择头部和下巴的侧向稳定以及前额绑带,那么在加载和卸载过程中或在现代救护车的运输过程中额外使用硬质颈椎矫形器对颈椎的活动限制并无相关优势。因此,在将病人安置在真空床垫和担架上之后,移除最初用于现场抢救病人的硬质颈椎矫形器,以避免硬质颈椎矫形器在送往医院的途中可能产生的负面影响,可能是有利的。
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[Transport of severely injured trauma patients in an ambulance with and without a rigid neck orthosis: comparative biomechanical measurements].

Background: The actual significance of prehospital immobilization of the cervical spine in severely injured trauma patients remains unclear. In view of possible negative implications, such as an increase in intracranial pressure due to the application of a rigid cervical spine orthosis, the long-term use must be critically questioned. Further studies are required to justify the long-term use of a rigid cervical spine orthosis in the prehospital setting.

Objective: Comparative measurements of the mobility of the cervical spine during immobilization using a vacuum mattress with or without the additional application of a rigid cervical spine orthosis after positioning on the stretcher were carried out.

Material and methods: Biomechanical measurements of the movement of the cervical spine were carried out by attaching inertial measurement units to a test person during the loading and unloading process in a modern ambulance and during the journey along a predefined parkour. The test person on whom the measurements were carried out was immobilized on a vacuum mattress with the option of lateral fixation of the head and chin and forehead strap on an electrohydraulic stretcher. The complete standard monitoring was set up to simulate as realistic a transport of a severely injured patient as possible. A total of 30 test runs were realized. In one half of the tests, the cervical spine was additionally immobilized using a rigid orthosis and in the other half a cervical spine orthosis was not used. For each of the 30 tests, the angles, axial rotation, lateral bending and flexion/extension as well as the first and second derivatives were considered for loading, transport and unloading and the parameters mean deviation from the zero position, size of the swept angle range and maximum were calculated for each test run.

Results: Statistically significant differences were only found for some biomechanical parameters in the sagittal plane (flexion and extension). No significant differences were found for the measured parameters in the other directions of movement (axial rotation, lateral flexion). In general, only very small angular deflections were measured both in the tests with the cervical spine orthosis and without the cervical spine orthosis (on average in the range of 1-2° for axial rotation and flexion/extension and up to 3° for lateral flexion).

Conclusion: If immobilization is carried out correctly using a vacuum mattress with the option of lateral stabilization of the head and chin and a forehead strap on an electrohydraulic stretcher with a loading system, there are no relevant advantages with respect to the restriction of movement of the cervical spine by the additional use of a rigid cervical spine orthosis for the loading and unloading process or during the transport in a modern ambulance. It could therefore be advantageous to remove the rigid cervical spine orthosis initially applied for the rescue of the patient at the scene after the patient has been positioned on the vacuum mattress and stretcher to avoid potential negative effects of the rigid cervical spine orthosis for the period of transportation to the hospital.

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