两种可调节式和两种标准式颈托对颈椎活动范围限制及颅面组织界面压力的比较
Comparison of Cervical Range-of-Motion Restriction and Craniofacial Tissue-Interface Pressure With 2 Adjustable and 2 Standard Cervical Collars.
作者信息
Tescher Ann N, Rindflesch Aaron B, Youdas James W, Terman Ross W, Jacobson Therese M, Douglas Lisa L, Miers Anne G, Austin Christine M, Delgado Adriana M, Zins Savannah M, Lahr Brian D, Pichelmann Mark A, Heller Stephanie F, Huddleston Paul M
机构信息
*Department of Nursing, Mayo Clinic, Rochester, Minnesota†Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota‡Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, Minnesota§Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota¶Mayo School of Health Sciences, Physical Therapy Program, College of Medicine, Mayo Clinic, Jacksonville, Florida||Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida**Prosthetic Laboratories Inc., Rochester, Minnesota.
出版信息
Spine (Phila Pa 1976). 2016 Mar;41(6):E304-12. doi: 10.1097/BRS.0000000000001252.
STUDY DESIGN
Randomized controlled trial.
OBJECTIVE
The aim of the study was to compare and contrast the restrictiveness and tissue-interface pressure (TIP) characteristics of 2 standard and 2 adjustable cervical collars.
SUMMARY OF BACKGROUND DATA
This study compared the restrictiveness and TIP of 4 commercially available cervical collars (2 standard and 2 adjustable). Adjustable collars offer potential advantages of individualized fit for patients and decreased inventory for institutions. The overall goal was to determine whether the adjustable collars provided the same benefits of cervical range-of-motion (CROM) restriction as the standard collars without increasing TIP and risk of pressure-related complications.
METHODS
A total of 48 adult volunteer subjects (24 men and 24 women) were fitted with 4 collars (Aspen, Aspen Vista, Miami J, and Miami J Advanced) in random order. Data collection included assessment of CROM restrictiveness and measurement of TIP on the mandible and occiput in upright and supine positions. The experimental, repeated measures design stratified the sample by body mass index (BMI) and sex.
RESULTS
All collars restricted CROM as compared with no collar (P ≤ 0.001 each). Aspen was more restrictive than Aspen Vista and Miami J in 4 movement planes (P ≤ 0.003 each), but not significantly different from Miami J Advanced. The Miami J standard collar was associated with significantly lower peak TIPs on all sites and in all positions compared with Aspen (P ≤ 0.001), Miami J Advanced (P < 0.001), and Aspen Vista (P = 0.01 for mandible site and upright position, P < 0.001 for remaining sites and positions). Increased peak TIP correlated with high BMI across all collar types, but was significantly lower for the Miami J collar than the Aspen collar.
CONCLUSION
All collars, compared with no collar, significantly restricted CROM. Although the collar-to-collar comparisons were statistically significant, the differences may have little clinical significance in the acutely injured trauma patient. The Miami J standard collar had the lowest overall TIP in both sites and positions. Ongoing effort should be devoted to staff education in proper sizing and fit, particularly for patients with high BMI.
研究设计
随机对照试验。
目的
本研究旨在比较和对比2种标准型和2种可调节型颈托的限制程度和组织界面压力（TIP）特征。
背景数据总结
本研究比较了4种市售颈托（2种标准型和2种可调节型）的限制程度和TIP。可调节型颈托为患者提供了个性化贴合的潜在优势，并减少了机构的库存。总体目标是确定可调节型颈托在不增加TIP和压力相关并发症风险的情况下，是否能提供与标准型颈托相同的颈椎活动范围（CROM）限制效果。
方法
总共48名成年志愿者受试者（24名男性和24名女性）被随机佩戴4种颈托（阿斯彭、阿斯彭维斯塔、迈阿密J和迈阿密J高级款）。数据收集包括评估CROM限制程度以及测量直立位和仰卧位时下颌骨和枕骨的TIP。实验性重复测量设计按体重指数（BMI）和性别对样本进行分层。
结果
与不佩戴颈托相比，所有颈托均限制了CROM（每种情况P≤0.001）。在4个运动平面上，阿斯彭比阿斯彭维斯塔和迈阿密J更具限制性（每种情况P≤0.003），但与迈阿密J高级款无显著差异。与阿斯彭（P≤0.001）、迈阿密J高级款（P<0.001）和阿斯彭维斯塔（下颌骨部位和直立位P = 0.01，其余部位和体位P<0.001）相比，迈阿密J标准型颈托在所有部位和体位的峰值TIP均显著更低。在所有颈托类型中，峰值TIP的增加与高BMI相关，但迈阿密J颈托的峰值TIP显著低于阿斯彭颈托。
结论
与不佩戴颈托相比，所有颈托均显著限制了CROM。尽管颈托之间的比较在统计学上有显著差异，但这些差异对于急性受伤的创伤患者可能临床意义不大。迈阿密J标准型颈托在两个部位和体位的总体TIP最低。应持续致力于对工作人员进行正确尺寸选择和佩戴的培训，特别是对于高BMI的患者。
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