Trauma Unit, Department of Surgery, Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Department of Surgery, Gelre Hospitals, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, The Netherlands.
Eur Spine J. 2018 Dec;27(12):2999-3006. doi: 10.1007/s00586-018-5762-2. Epub 2018 Sep 15.
The practice of prehospital immobilization is coming under increasing scrutiny. Unravelling the historical sequence of prehospital immobilization might shed more light on this matter and help resolve the situation. Main purpose of this review is to provide an overview of the development and reasoning behind the implementation of prehospital spine immobilization.
An extensive search throughout historical literature and recent evidence based studies was conducted.
The history of treating spinal injuries dates back to prehistoric times. Descriptions of prehospital spinal immobilization are more recent and span two distinct periods. First documentation of its use comes from the early 19th century, when prehospital trauma care was introduced on the battlefields of the Napoleonic wars. The advent of radiology gradually helped to clarify the underlying pathology. In recent decades, adoption of advanced trauma life support has elevated in-hospital trauma-care to an high standard. Practice of in-hospital spine immobilization in case of suspected injury has also been implemented as standard-care in prehospital setting. Evidence for and against prehospital immobilization is equally divided in recent evidence-based studies. In addition, recent studies have shown negative side-effects of immobilisation in penetrating injuries.
Although widely implementation of spinal immobilization to prevent spinal cord injury in both penetrating and blunt injury, it cannot be explained historically. Furthermore, there is no high-level scientific evidence to support or reject immobilisation in blunt injury. Since evidence in favour and against prehospital immobilization is equally divided, the present situation appears to have reached something of a deadlock. These slides can be retrieved under Electronic Supplementary Material.
院前固定的做法正受到越来越多的审查。解开院前固定的历史顺序可能会对此事有更多的了解，并有助于解决这种情况。本综述的主要目的是提供院前脊柱固定的发展和实施背后的原理概述。
对历史文献和近期基于证据的研究进行了广泛的搜索。
治疗脊柱损伤的历史可以追溯到史前时代。关于院前脊柱固定的描述则更近一些，分为两个不同的时期。第一次记录其使用是在 19 世纪初，当时在拿破仑战争的战场上引入了院前创伤护理。放射学的出现逐渐帮助澄清了潜在的病理。近几十年来，先进的创伤生命支持的采用将医院内创伤护理提升到了一个高标准。在疑似受伤的情况下，在院前环境中对脊柱进行固定的做法也已作为标准护理实施。最近的基于证据的研究对院前固定的利弊同样存在分歧。此外，最近的研究表明，在穿透性损伤中固定会产生负面影响。
尽管广泛实施脊柱固定以防止穿透性和钝性损伤中的脊髓损伤，但从历史上看，这是无法解释的。此外，没有高水平的科学证据支持或拒绝在钝性损伤中进行固定。由于支持和反对院前固定的证据同样存在分歧，目前的情况似乎陷入了僵局。这些幻灯片可以在电子补充材料中检索到。
