Department of Orthopedics, Strong Memorial Hospital, University of Rochester, Rochester, New York 14618, USA.
J Trauma Acute Care Surg. 2012 Jun;72(6):1609-13. doi: 10.1097/TA.0b013e3182471d9f.
Many studies have compared the restriction of motion that immobilization collars provide to the injured victim. No previous investigation has assessed the amount of motion that is generated during the fitting and removal process. The purpose of this study was to compare the three-dimensional motion generated when one-piece and two-piece cervical collars are applied and removed from cadavers intact and with unstable cervical spine injuries.
Five fresh, lightly embalmed cadavers were tested three times each with either a one-piece or two-piece cervical collar in the supine position. Testing was performed in the intact state, following creation of a global ligamentous instability at C5-C6. The amount of angular motion resulting from the collar application and removal was measured using a Fastrak, three-dimensional, electromagnetic motion analysis device (Polhemus Inc., Colchester, VT). The measurements recorded in this investigation included maximum values for flexion/extension, axial rotation, medial/lateral flexion, anterior/posterior displacement, axial distraction, and medial/lateral displacement at the level of instability.
There was statistically more motion observed with application or removal of either collar following the creation of a global instability. During application, there was a statistically significant difference in flexion/extension between the one-piece (1.8 degrees) and two-piece (2.6 degrees) collars, p = 0.009. There was also a statistically significant difference in anterior/posterior translation between the one-piece (3.6 mm) and two-piece (3.4 mm) collars, p = 0.015. The maximum angulation and displacement during the application of either collar was 3.4 degrees and 4.4 mm. Statistical analysis revealed no significant differences between the one-piece and two-piece collars during the removal process. The maximum angulation and displacement during removal of either collar type was 1.6 degrees and 2.9 mm.
There were statistically significant differences in motion between the one-piece and two-piece collars during the application process, but it was only 1.2 degrees in flexion/extension and 0.2 mm in anterior/posterior translation. Overall, the greatest amount of angulation and displacement observed during collar application was 3.4 degrees and 4.4 mm. Although the exact amount of motion that could be deleterious to a cervical spine-injured patient is unknown, collars can be placed and removed with manual in-line stabilization without large displacements. Only trained practitioners should do so and with great care given that some motion in all planes does occur during the process.
许多研究比较了固定颈托对受伤患者的活动限制。以前没有研究评估过在安装和拆卸过程中产生的运动量。本研究的目的是比较一体式和分体式颈椎托在完整和伴有不稳定颈椎损伤的尸体上安装和拆卸时产生的三维运动。
5 具新鲜、轻度防腐的尸体，仰卧位分别使用一体式或分体式颈椎托各测试 3 次。测试在完整状态下进行，然后在 C5-C6 处造成寰枢关节韧带整体不稳定。使用 Fastrak 三维电磁运动分析装置（Polhemus Inc.，Colchester，VT）测量颈托安装和拆卸引起的角度运动。本研究记录的测量值包括不稳定水平处屈伸、轴向旋转、内外侧弯曲、前后位移、轴向分离和内外侧位移的最大值。
寰枢关节韧带整体不稳定后，使用任何一种颈托进行安装或拆卸时，观察到的运动都明显增加。安装时，一体式（1.8 度）和分体式（2.6 度）颈托的屈伸差异具有统计学意义，p = 0.009。一体式（3.6mm）和分体式（3.4mm）颈托的前后位移差异也具有统计学意义，p = 0.015。在安装任何一种颈托时，最大角度和位移为 3.4 度和 4.4 毫米。统计分析显示，在拆卸过程中，一体式和分体式颈托之间没有显著差异。拆卸任何一种颈托时的最大角度和位移均为 1.6 度和 2.9 毫米。
在安装过程中，一体式和分体式颈托之间的运动存在统计学差异，但屈伸差异仅为 1.2 度，前后位移差异为 0.2mm。总体而言，在颈托安装过程中观察到的最大角度和位移为 3.4 度和 4.4 毫米。虽然尚不清楚对颈椎受伤患者造成损害的确切运动量，但可以在手动直线稳定下进行颈托的放置和拆卸，而不会产生大的位移。只有经过培训的医生才能进行此项操作，而且必须非常小心，因为在整个过程中确实会在所有平面上发生一定程度的运动。
