Manix T, Gunderson M R, Garth G C
Laerdal California, Inc., Long Beach, CA 90804, USA.
Prehosp Disaster Med. 1995 Oct-Dec;10(4):232-7; discussion 237-8. doi: 10.1017/s1049023x00042096.
Previous evaluations of prehospital devices intended for spinal immobilization have focused on the device's ability to restrict motion only. This study defines six relevant criteria for evaluation of cervical immobilization device (CID) performance.
To suggest relevant criteria for evaluation and use available technology to improve measurements for performance testing of prehospital-care devices.
Six parameters (motion restriction, access, ease of application, environmental performance, radiolucency, and storage size) were used to evaluate three types of CIDs: Device A--a single-use corrugated board; Device B--a reusable foam-block CID; and Device C--hospital towels and adhesive tape. To test motion restriction, the most frequently compared parameters for immobilization devices, 20 volunteers were asked to move their heads and necks through a series of motions (flexion, extension, lateral bending, and rotation). Their movements were videotaped, still images of each movement were generated, and the degrees of deflection recorded from these still images. To ensure a consistent level of force, electromyography (EMG) of the sternoclydomastoid and extensor muscles was employed.
Data were produced for each parameter and presented for comparison. The use of video to determine deflection proved to be a useful and highly accurate (+/- 1o) method for measurement. The use of EMG technology enabled force to be controlled indirectly when the subjects used moderate levels of exertion. Overall, Devices A and C restricted motion better than Device B. Although Device C required the shortest time for application, it took the longest to prepare for application. The total time required for preparation and application of A and B essentially were equivalent, with A requiring no preparation time but taking the longest for application, and B having an intermediate interval for application. Device A allowed for the best examination of the head and neck. No differences were detected in performance in extreme environmental conditions or in radiolucency for cervical spine X-ray examinations. Device A consumed the smallest storage volume, B the greatest storage volume, and C an intermediate volume substantially greater than that required for A.
Device evaluation should include examination of all relevant performance parameters using the most accurate and meaningful methods possible.
以往对用于脊柱固定的院前设备的评估仅侧重于设备限制运动的能力。本研究定义了六项评估颈椎固定装置（CID）性能的相关标准。
提出相关评估标准，并利用现有技术改进院前护理设备性能测试的测量方法。
使用六个参数（运动限制、可及性、应用简易性、环境性能、射线可透性和储存尺寸）来评估三种类型的CID：设备A——一次性瓦楞纸板；设备B——可重复使用的泡沫块CID；设备C——医院毛巾和胶带。为测试运动限制这一固定装置最常被比较的参数，让20名志愿者通过一系列动作（前屈、后伸、侧弯和旋转）来移动他们的头部和颈部。对他们的动作进行录像，生成每个动作的静态图像，并从这些静态图像中记录偏转程度。为确保力的水平一致，采用了胸锁乳突肌和伸肌的肌电图（EMG）。
针对每个参数生成了数据并进行了比较。事实证明，使用视频确定偏转是一种有用且高度准确（±1°）的测量方法。当受试者适度用力时，肌电图技术能够间接控制力量。总体而言，设备A和C比设备B能更好地限制运动。虽然设备C应用所需时间最短，但准备应用的时间最长。设备A和B准备和应用所需的总时间基本相当，其中A无需准备时间但应用时间最长，B的应用间隔时间居中。设备A对头颈部的检查最为便利。在极端环境条件下的性能或颈椎X线检查的射线可透性方面未检测到差异。设备A占用的存储空间最小，B最大，C的存储空间居中且远大于A所需的空间。
设备评估应使用尽可能准确和有意义的方法对所有相关性能参数进行检查。
