Liao Shiyao, Popp Erik, Hüttlin Petra, Weilbacher Frank, Münzberg Matthias, Schneider Niko, Kreinest Michael
Department of Trauma Surgery and Orthopedics, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.
Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany.
BMJ Open. 2017 Sep 1;7(8):e015307. doi: 10.1136/bmjopen-2016-015307.
Emergency management of upper cervical spine injuries often requires cervical spine immobilisation and some critical patients also require airway management. The movement of cervical spine created by tracheal intubation and cervical spine immobilisation can potentially exacerbate cervical spinal cord injury. However, the evidence that previous studies have provided remains unclear, due to lack of a direct measurement technique for dural sac's space during dynamic processes. Our study will use myelography method and a wireless human motion tracker to characterise and compare the change of dural sac's space during tracheal intubations and cervical spine immobilisation in the presence of unstable upper cervical spine injury such as atlanto-occipital dislocation or type II odontoid fracture.
Perform laryngoscopy and intubation, video laryngoscope intubation, laryngeal tube insertion, fiberoptic intubation and cervical collar application on cadaveric models of unstable upper cervical spine injury such as atlanto-occipital dislocation or type II odontoid fracture. The change of dural sac's space and the motion of unstable cervical segment are recorded by video fluoroscopy with previously performing myelography, which enables us to directly measure dural sac's space. Simultaneously, the whole cervical spine motion is recorded at a wireless human motion tracker. The maximum dural sac compression and the maximum angulation and distraction of the injured segment are measured by reviewing fluoroscopic and myelography images.
This study protocol has been approved by the Ethics Committee of the State Medical Association Rhineland-Palatinate, Mainz, Germany. The results will be published in relevant emergency journals and presented at relevant conferences.
DRKS00010499.
上颈椎损伤的急诊处理通常需要颈椎固定，一些重症患者还需要气道管理。气管插管和颈椎固定所产生的颈椎活动可能会加重颈脊髓损伤。然而，由于缺乏动态过程中硬脊膜囊间隙的直接测量技术，以往研究提供的证据仍不明确。我们的研究将使用脊髓造影方法和无线人体运动追踪器，来描述和比较在存在寰枕脱位或Ⅱ型齿状突骨折等不稳定上颈椎损伤的情况下，气管插管和颈椎固定过程中硬脊膜囊间隙的变化。
在寰枕脱位或Ⅱ型齿状突骨折等不稳定上颈椎损伤的尸体模型上进行喉镜检查及插管、视频喉镜插管、喉罩置入、纤维光导喉镜插管和应用颈托。通过预先进行脊髓造影的视频荧光透视来记录硬脊膜囊间隙的变化和不稳定颈椎节段的运动，这使我们能够直接测量硬脊膜囊间隙。同时，在无线人体运动追踪器上记录整个颈椎的运动。通过回顾荧光透视和脊髓造影图像，测量硬脊膜囊的最大压缩程度以及损伤节段的最大成角和牵张程度。
本研究方案已获得德国美因茨莱茵兰 - 普法尔茨州医学协会伦理委员会的批准。研究结果将发表在相关急诊医学期刊上，并在相关会议上展示。
DRKS00010499。
