Department of Orthopaedic Surgery, University of Texas, Houston, TX 77030, USA.
J Neurosurg Spine. 2012 May;16(5):504-8. doi: 10.3171/2012.2.SPINE11621. Epub 2012 Mar 2.
The proper prehospital and inpatient management of patients with unstable spinal injuries is critical for prevention of secondary neurological compromise. The authors sought to analyze the amount of motion generated in the unstable thoracolumbar spine during various maneuvers and transfers that a trauma patient would typically be subjected to prior to definitive fixation.
Five fresh cadavers with surgically created unstable L-1 burst fractures were tested. The amount of angular motion between the T-12 and L-2 vertebral segments was measured using a 3D electromagnetic motion analysis device. A complete sequence of maneuvers and transfers was then performed that a patient would be expected to go through from the time of injury until surgical fixation. These maneuvers and transfers included spine board placement and removal, bed transfers, lateral therapy, and turning the patient prone onto the operating table. During each of these, the authors performed what they believed to be the most commonly used versus the best techniques for preventing undesirable motion at the injury level.
When placing a spine board there was more motion in all 3 planes with the log-roll technique, and this difference reached statistical significance for axial rotation (p = 0.018) and lateral bending (p = 0.003). Using logrolling for spine board removal resulted in increased motion again, and this was statistically significant for flexion-extension (p = 0.014). During the bed transfer and lateral therapy, the log-roll technique resulted in more motion in all 3 planes (p ≤ 0.05). When turning the cadavers prone for surgery there was statistically more angular motion in each plane for manually turning the patient versus the Jackson table turn (p ≤ 0.01). The total motion was decreased by almost 50% in each plane when using an alternative to the log-roll techniques during the complete sequence (p ≤ 0.007).
Although it is unknown how much motion in the unstable spine is necessary to cause secondary neurological injury, the accepted tenet is to minimize motion as much as possible. This study has demonstrated the angular motion incurred by the unstable thoracolumbar spine as experienced by the typical trauma patient from the field to positioning in the operating room using the best and most commonly used techniques. As previously reported, using the log-roll technique consistently results in unwanted motion at the injured spinal segment.
不稳定脊柱损伤患者的恰当院前和住院管理对预防继发性神经损伤至关重要。作者旨在分析创伤患者在接受确定性固定之前通常经历的各种操作和转移过程中不稳定胸腰椎脊柱产生的运动幅度。
对 5 具具有手术造成的不稳定 L-1 爆裂性骨折的新鲜尸体进行了测试。使用三维电磁运动分析设备测量 T-12 和 L-2 椎骨节段之间的角度运动。然后进行了完整的操作和转移序列，这是患者从受伤到接受手术固定时可能经历的过程。这些操作和转移包括脊柱板的放置和移除、病床转移、侧卧位治疗以及将患者翻转到手术台上。在进行这些操作时，作者进行了他们认为最常用于防止损伤水平不良运动的技术，以及最常用技术。
放置脊柱板时，日志滚动技术在所有 3 个平面上的运动幅度更大，轴向旋转（p = 0.018）和侧屈（p = 0.003）的差异具有统计学意义。使用日志滚动进行脊柱板移除再次导致运动幅度增加，屈伸（p = 0.014）具有统计学意义。在病床转移和侧卧位治疗过程中，日志滚动技术导致所有 3 个平面的运动幅度更大（p ≤ 0.05）。当将尸体翻转到手术台上时，与杰克逊表翻转相比，手动翻转患者在每个平面上的角度运动都具有统计学意义（p ≤ 0.01）。在整个序列中使用日志滚动技术的替代方法时，每个平面的总运动减少了近 50%（p ≤ 0.007）。
虽然尚不清楚不稳定脊柱运动幅度需要多大才能导致继发性神经损伤，但公认的原则是尽可能减少运动。本研究通过使用最佳和最常用技术，从现场到手术室定位，演示了典型创伤患者在不稳定胸腰椎脊柱上经历的角度运动幅度。如前所述，使用日志滚动技术始终会导致受伤脊柱节段出现不期望的运动。
