Department of Orthopedics and Rehabilitation, University of Wisconsin , Madison , WI, USA.
J Am Acad Orthop Surg. 2010 Mar;18(3):149-59. doi: 10.5435/00124635-201003000-00004.
The goal of cervical spine clearance is to establish that injuries are not present. Patients are classified into four groups: asymptomatic, temporarily nonassessable secondary to distracting injuries or intoxication, symptomatic, and obtunded. Level I evidence supports that the asymptomatic patient can be cleared on clinical grounds and does not require imaging. The temporarily nonassessable patient may have short-term mental status changes (eg, intoxication, painful distracting injuries) and can be evaluated by two methods. When there is urgency, the evaluation is similar to that for the obtunded patient. Alternatively, the patient can be reevaluated within 24 to 48 hours, after return of mentation or following treatment of painful injuries. The patient then can be assessed as the asymptomatic patient is. The symptomatic patient requires advanced imaging. The obtunded patient should undergo, at minimum, a multidetector CT scan. Two methods are advocated. One uses only multidetector CT; a normal result is sufficient to clear the obtunded patient. The alternative method is obtaining a magnetic resonance image subsequent to a negative multidetector CT scan. Because at present information is insufficient to determine whether MRI is indicated, this is an area of controversy.
颈椎清除的目标是确定是否存在损伤。患者分为四组：无症状、因分散性损伤或中毒而暂时无法评估、有症状和意识不清。一级证据支持无症状患者可以根据临床情况进行清除，不需要进行影像学检查。暂时无法评估的患者可能有短期的精神状态改变（如中毒、疼痛的分散性损伤），可以通过两种方法进行评估。当情况紧急时，评估类似于对意识不清的患者进行的评估。或者，患者可以在神志恢复或疼痛损伤治疗后 24 至 48 小时内重新评估，然后可以像评估无症状患者一样进行评估。有症状的患者需要进行高级影像学检查。意识不清的患者应至少进行多排 CT 扫描。有两种方法被提倡。一种仅使用多排 CT；正常结果足以清除意识不清的患者。另一种方法是在多排 CT 扫描阴性后进行磁共振成像。由于目前信息不足以确定是否需要 MRI，这是一个有争议的领域。
