Department of Orthopaedic Surgery 357, Radboud University Nijmegen Medical Centre, Postbox 9101, 6500 HB Nijmegen, The Netherlands.
Emerg Med J. 2012 Feb;29(2):104-7. doi: 10.1136/emj.2010.092973. Epub 2011 Feb 18.
All trauma patients with a cervical spinal column injury or with a mechanism of injury with the potential to cause cervical spinal injury should be immobilised until a spinal injury is excluded. Immobilisation of the entire patient with a rigid cervical collar, backboard, head blocks with tape or straps is recommended by the Advanced Trauma Life Support guidelines. However there is insufficient evidence to support these guidelines.
To analyse the effects on the range of motion of the addition of a rigid collar to head blocks strapped on a backboard.
The active range of motion of the cervical spine was determined by computerised digital dual inclinometry, in 10 healthy volunteers with a rigid collar, head blocks strapped on a padded spine board and a combination of both. Maximal opening of the mouth with all types of immobiliser in place was also measured.
The addition of a rigid collar to head blocks strapped on a spine board did not result in extra immobilisation of the cervical spine. Opening of the mouth was significantly reduced in patients with a rigid collar.
Based on this proof of principle study and other previous evidence of adverse effects of rigid collars, the addition of a rigid collar to head blocks is considered unnecessary and potentially dangerous. Therefore the use of this combination of cervical spine immobilisers must be reconsidered.
所有颈椎损伤或可能导致颈椎损伤的创伤患者都应在排除脊柱损伤之前进行固定。高级创伤生命支持指南建议使用刚性颈圈、背板、头部固定器并用胶带或带子固定整个患者。然而，没有足够的证据支持这些指南。
分析在背板上用带子固定头部固定器上增加刚性颈圈对颈椎活动范围的影响。
通过计算机数字双倾斜计，在 10 名健康志愿者中确定颈椎的主动活动范围，分别使用刚性颈圈、背板上用带子固定的头部固定器以及两者的组合。还测量了所有类型的固定器固定时最大张口度。
在背板上用带子固定的头部固定器上增加刚性颈圈不会导致颈椎的额外固定。使用刚性颈圈时，张口度明显减小。
基于这一原理研究和其他先前关于刚性颈圈不良影响的证据，认为在头部固定器上增加刚性颈圈是不必要的，且可能有危险。因此，必须重新考虑这种颈椎固定器的组合使用。
