Prasarn Mark L, Horodyski MaryBeth, Schneider Prism, Wendling Adam, Hagberg Carin A, Rechtine Glenn R
Department of Orthopaedic Surgery, University of Texas, Houston, Texas.
Department of Orthopaedic Surgery, University of Florida, Gainesville, Florida.
J Emerg Med. 2016 Mar;50(3):427-32. doi: 10.1016/j.jemermed.2015.09.009. Epub 2015 Oct 21.
It has been proposed that cricoid pressure can exacerbate an unstable cervical injury and lead to neurologic deterioration.
We sought to examine the amount of motion cricoid pressure could cause at an unstable subaxial cervical spine injury, and whether posterior manual support is of any benefit.
Five fresh, whole cadavers had complete segmental instability at C5-C6 surgically created by a fellowship-trained spine surgeon. Cricoid pressure was applied to the anterior cricoid by an attending anesthesiologist. In addition, the effect of posterior cervical support was tested during the trials. The amount of angular and linear motion between C5 and C6 was measured using a Fastrak, three-dimensional, electromagnetic motion analysis device (Polhemus Inc., Colchester, VT).
When cricoid pressure is applied, the largest angular motion was 3 degrees and occurred in flexion-extension at C5-C6. The largest linear displacement was 1.36 mm and was in anterior-posterior displacement of C5-C6. When manual posterior cervical support was applied, the flexion-extension was improved to less than half this value (1.43 degrees), and this reached statistical significance (p = 0.001). No other differences were observed to be significant in the other planes of motion with the applications of support.
Based on the evidence presented, we believe that the application of cricoid pressure to a patient with a globally unstable subaxial cervical spine injury causes small displacements. There may be some benefit to the use of manual posterior cervical spine support for reducing motion at such an injured segment.
有人提出环状软骨压迫可能会加重不稳定的颈椎损伤并导致神经功能恶化。
我们试图研究环状软骨压迫在不稳定的下颈椎损伤时可能引起的活动量，以及后路手动支撑是否有益。
五具新鲜完整的尸体由一位接受过专科培训的脊柱外科医生通过手术造成C5-C6节段完全性不稳定。由主治麻醉医生对环状软骨前部施加环状软骨压迫。此外，在试验过程中测试了颈椎后路支撑的效果。使用Fastrak三维电磁运动分析设备（Polhemus公司，佛蒙特州科尔切斯特）测量C5和C6之间的角向和线性运动量。
施加环状软骨压迫时，最大角向运动为3度，发生在C5-C6的屈伸运动中。最大线性位移为1.36毫米，发生在C5-C6的前后位移中。当施加颈椎后路手动支撑时，屈伸运动改善至该值的一半以下（1.43度），且具有统计学意义（p = 0.001）。在应用支撑的其他运动平面上未观察到其他显著差异。
基于所提供的证据，我们认为对下颈椎整体不稳定损伤的患者施加环状软骨压迫会导致微小位移。使用颈椎后路手动支撑可能有助于减少此类损伤节段的活动。
