Anderson Richard C E, Scaife Eric R, Fenton Stephen J, Kan Peter, Hansen Kris W, Brockmeyer Douglas L
Department of Neurosurgery, Children's Hospital of New York, Columbia University College of Physicians and Surgeons, New York, New York, USA.
J Neurosurg. 2006 Nov;105(5 Suppl):361-4. doi: 10.3171/ped.2006.105.5.361.
Currently, no diagnostic or procedural standards exist for clearing the cervical spine in children after trauma. The establishment of protocols has been shown to reduce the time required to accomplish clearance and reduce the number of missed injuries. The purpose of this study was to determine if reeducation and initiation of a new protocol based on the National Emergency X-Radiography Utilization Study criteria could safely increase the number of pediatric cervical spines cleared by nonneurosurgical personnel.
The authors collected and reviewed data regarding cervical spine clearance in children (age range 0-18 years) who presented to the emergency department at Primary Children's Medical Center in Salt Lake City, Utah, between 2001 and 2006 after sustaining significant trauma. Radiographic and clinical methods of clearing the cervical spine, as well as the type and management of injuries, were determined for two periods: Period I (January 2001-December 2003) and Period II (January 2004-February 2006). Between 2001 and 2003, 95% of 936 cervical spines were cleared by the neurosurgical service. Twenty-one ligamentous injuries (2.2%) and 12 fracture/dislocations (1.3%) were detected, and five patients (0.5%) required operative stabilization. Since January 2004, 585 (62.4%) of 937 cervical spines have been cleared by nonneurosurgical personnel. Twelve ligamentous injuries (1.3%) and 14 fracture/dislocations (1.5%) were identified, and four patients (0.4%) required operative stabilization. No late injuries were detected in either time period.
The protocol outlined in the paper has been effective in detecting cervical spine injuries in children after trauma and has increased the number of cervical spines cleared by nonneurosurgical personnel by nearly 60%. Reeducation with the establishment of protocols can safely facilitate clearance of the cervical spine after trauma by nonneurosurgical personnel.
目前，对于儿童创伤后颈椎的评估尚无诊断或操作标准。已证实制定相关方案可减少完成评估所需的时间，并减少漏诊损伤的数量。本研究的目的是确定基于国家急诊X线摄影应用研究标准进行再培训并启动新方案，是否能安全地增加非神经外科人员对儿童颈椎的评估数量。
作者收集并回顾了2001年至2006年期间在犹他州盐湖城 Primary Children's Medical Center急诊科就诊、遭受重大创伤的儿童（年龄范围0 - 18岁）颈椎评估的数据。确定了两个时间段颈椎评估的影像学和临床方法，以及损伤的类型和处理方式：第一阶段（2001年1月 - 2003年12月）和第二阶段（2004年1月 - 2006年2月）。2001年至2003年期间，936例颈椎中有95%由神经外科进行评估。检测到21例韧带损伤（2.2%）和12例骨折/脱位（1.3%），5例患者（0.5%）需要手术稳定治疗。自2004年1月以来，937例颈椎中有585例（62.4%）由非神经外科人员评估。识别出12例韧带损伤（1.3%）和14例骨折/脱位（1.5%），4例患者（0.4%）需要手术稳定治疗。两个时间段均未检测到迟发性损伤。
本文所述方案在检测儿童创伤后颈椎损伤方面有效，并且使非神经外科人员评估的颈椎数量增加了近60%。通过制定方案进行再培训可安全地促进非神经外科人员对创伤后颈椎的评估。
