Chiu W C, Haan J M, Cushing B M, Kramer M E, Scalea T M
R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA.
J Trauma. 2001 Mar;50(3):457-63; discussion 464. doi: 10.1097/00005373-200103000-00009.
The potential for ligamentous injury of the cervical spine (C-spine) may mandate prolonged neck immobilization via a hard cervical collar in the blunt trauma victim (BTV) with altered sensorium. We investigated the incidence of ligamentous C-spine injuries, and whether applying (post hoc) the practice management guidelines from the Eastern Association for the Surgery of Trauma (three radiograph views plus computed tomographic scan of C1-C2) would have detected the injuries.
The study was a 3-year retrospective review of BTVs admitted to the state's Primary Adult Resource Center for trauma from 1996 to 1998. Unreliable patients were defined as those with admission Glasgow Coma Scale score < 15. A rigorous algorithm to clear the C-spine was used. Pure ligamentous C-spine injury was defined as a C-spine having abnormal anatomic alignment, dislocation, subluxation, or listhesis, but without fracture. Demographics, diagnostic studies, presence of neurologic deficit, therapy, survival, and disposition were analyzed.
There were 14,577 BTVs with 614 (4.2%) patients having C-spine injury. There were 2,605 (18%) unreliable patients, with 143 (5.5%) of these having C-spine injury, 129 (90%) having fracture and 14 (10% of BTVs; 0.5% of unreliable patients) having no fracture. Of the 14 unreliable patients with pure ligamentous C-spine injury, 13 had initial diagnosis by supine cross-table lateral radiograph. The one exception had a normal three-view radiographic series, but atlanto-occipital dislocation was diagnosed by computed tomographic scan. Eight patients had upper level injury (C0-C4) and six were lower (C4-C7). Four patients died within 30 minutes after admission, 4 underwent cervical fusion, and 6 were treated with collar only. Five (50%) of the survivors had no apparent neurologic deficit attributed to the C-spine at admission. Nine patients remained institutionalized after discharge and one was discharged home.
Ligamentous injuries without fracture of the C-spine are rare. Application of the practice management guidelines developed by the Eastern Association for the Surgery of Trauma for identifying C-spine instability is effective and should facilitate early removal of the cervical collar in unreliable patients.
颈椎（C 型脊柱）韧带损伤的可能性可能要求通过硬颈托对意识改变的钝性创伤受害者（BTV）进行长时间颈部固定。我们调查了颈椎韧带损伤的发生率，以及应用（事后）东部创伤外科学会的实践管理指南（三张 X 光片视图加 C1 - C2 的计算机断层扫描）是否能检测到这些损伤。
该研究是对 1996 年至 1998 年入住该州主要成人创伤资源中心的 BTV 进行的为期 3 年的回顾性研究。不可靠患者定义为入院格拉斯哥昏迷量表评分<15 的患者。采用了一种严格的颈椎清除算法。单纯颈椎韧带损伤定义为颈椎解剖排列异常、脱位、半脱位或滑脱，但无骨折。分析了人口统计学、诊断研究、神经功能缺损的存在、治疗、生存情况和处置情况。
共有 14577 名 BTV，其中 614 名（4.2%）患者有颈椎损伤。有 2605 名（18%）不可靠患者，其中 143 名（5.5%）有颈椎损伤，129 名（90%）有骨折，14 名（占 BTV 的 10%；不可靠患者的 0.5%）无骨折。在 14 名单纯颈椎韧带损伤的不可靠患者中，13 名通过仰卧位交叉台侧位 X 光片初步诊断。唯一的例外是三张 X 光片系列正常，但通过计算机断层扫描诊断为寰枕脱位。8 名患者为上位损伤（C0 - C4），6 名患者为下位损伤（C4 - C7）。4 名患者在入院后 30 分钟内死亡，4 名接受了颈椎融合术，6 名仅用颈托治疗。5 名（50%）幸存者入院时没有明显归因于颈椎的神经功能缺损。9 名患者出院后仍住院，1 名出院回家。
无骨折的颈椎韧带损伤很少见。应用东部创伤外科学会制定的实践管理指南来识别颈椎不稳定是有效的，并且应该有助于在不可靠患者中尽早去除颈托。
