Karbi O A, Caspari D A, Tator C H
Department of Emergency Medicine, Toronto General Hospital, Ont.
CMAJ. 1988 Oct 1;139(7):617-21.
Most cervical spine injuries are due to motor vehicle accidents. Proper extrication of the victims is vital; the ideal device should be easily assembled and applied, should facilitate removal of victims from automobile seats without changing the body's position, must not hinder airway access or the performance of cardiopulmonary resuscitation, must accommodate all types of patients, including children and obese or pregnant patients, and must completely immobilize the patient, especially if hyperextension is suspected. Current methods of immobilization, such as the use of a soft collar and sandbags, allow neck extension; the short board protects against extension but interferes with airway access. Newer devices are discussed in this article. Injuries of the upper cervical spine are less common but more serious than those of the lower portion and usually involve the vertebral arch. Radiologic examination of the first and second cervical vertebrae and the seventh cervical and first thoracic vertebrae should be emphasized. If lateral and anteroposterior views do not reveal abnormal findings and injury is still suspected, oblique views and computed or conventional tomography should be used. Cervical spinal cord injuries can be minimized or prevented if proper early management is applied.
大多数颈椎损伤是由机动车事故所致。妥善解救受害者至关重要；理想的装置应易于组装和应用，应便于将受害者从汽车座椅上移出而不改变身体位置，不得妨碍气道通畅或心肺复苏操作，必须适用于所有类型的患者，包括儿童、肥胖患者或孕妇，并且必须使患者完全固定，尤其是在怀疑有颈椎过度伸展时。当前的固定方法，如使用软颈托和沙袋，会导致颈部伸展；短板可防止伸展但会干扰气道通畅。本文将讨论更新的装置。上颈椎损伤比下颈椎损伤少见但更严重，且通常累及椎弓。应重点对第一、二颈椎以及第七颈椎和第一胸椎进行放射学检查。如果正侧位片未发现异常但仍怀疑有损伤，应采用斜位片以及计算机断层扫描或传统断层扫描。如果进行适当的早期处理，颈椎脊髓损伤可减至最小程度或得以预防。
