Kong Victor Y, Weale Ross D, Sartorius Benn, Bruce John L, Laing Grant L, Clarke Damian L
Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
Department of Surgery, Wessex Deanery, Wessex, UK.
Emerg Med Australas. 2018 Dec;30(6):773-776. doi: 10.1111/1742-6723.12985. Epub 2018 Apr 25.
Routine immobilisation of the cervical spine in trauma has been a long established practice. Very little is known in regard to its appropriateness in the specific setting of isolated traumatic brain injury secondary to gunshot wounds (GSWs).
A retrospective study was conducted over a 5 year period (January 2010 to December 2014) at the Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg, South Africa in order to determine the actual incidence of concomitant cervical spine injury (CSI) in the setting of isolated cerebral GSWs.
During the 5 year study period, 102 patients were included. Ninety-two per cent (94/102) were male and the mean age was 29 years. Ninety-eight per cent of the injuries were secondary to low velocity GSWs. Twenty-seven (26%) patients had cervical collar placed by the Emergency Medical Service. The remaining 75 patients had their cervical collar placed in the resuscitation room. Fifty-five (54%) patients had a Glasgow Coma Scale (GCS) of 15 and underwent plain radiography, all of which were normal. Clearance of cervical spine based on normal radiography combined with clinical assessment was achieved in all 55 (100%) patients. The remaining 47 patients whose GCS was <15 all underwent a computed tomography (CT) scan of their cervical spine and brain. All 47 CT scans of the cervical spine were normal and there was no detectable bone or soft tissue injury noted.
Patients who sustain an isolated low velocity cerebral GSW are highly unlikely to have concomitant CSI. Routine cervical spine immobilisation is unnecessary, and efforts should be directed at management strategies aiming to prevent secondary brain injury. Further studies are required to address the issue in the setting of high velocity GSWs.
颈椎在创伤时进行常规固定是长期以来的既定做法。对于其在枪伤（GSW）继发的单纯性创伤性脑损伤这一特定情况下的适用性，人们了解甚少。
在南非彼得马里茨堡市大都会创伤服务中心进行了一项为期5年（2010年1月至2014年12月）的回顾性研究，以确定单纯性脑GSW情况下颈椎损伤（CSI）的实际发生率。
在5年的研究期间，共纳入102例患者。92%（94/102）为男性，平均年龄为29岁。98%的损伤是由低速GSW继发的。27例（26%）患者由紧急医疗服务人员放置了颈托。其余75例患者在复苏室放置了颈托。55例（54%）格拉斯哥昏迷量表（GCS）评分为15分的患者接受了X线平片检查，结果均正常。所有55例（100%）患者通过X线平片结合临床评估实现了颈椎的排除。其余47例GCS评分<15分的患者均接受了颈椎和脑部的计算机断层扫描（CT）。所有47例颈椎CT扫描均正常，未发现可检测到的骨骼或软组织损伤。
遭受单纯性低速脑GSW的患者极不可能同时发生CSI。常规颈椎固定是不必要的，应将努力方向转向旨在预防继发性脑损伤的管理策略。在高速GSW情况下解决该问题还需要进一步研究。
