Faculty of Medicine, Eberhard Karls University Tübingen, 72076 Tuebingen, Germany; DRK Rettungsdienst Reutlingen, 72764 Reutlingen, Germany.
Department of Trauma and Orthopedic Surgery, BG Trauma Centre Ludwigshafen, 67071 Ludwigshafen, Germany.
Injury. 2020 Feb;51(2):185-192. doi: 10.1016/j.injury.2019.10.079. Epub 2019 Oct 25.
The extrication of patients following a road traffic collision is among the basic procedures in emergency medicine. Thus, extrication is a frequently performed procedure by most of the emergency medical services worldwide. The appropriate extrication procedure depends on the patient's current condition and accompanying injuries. A rapid extrication should be performed within a few minutes, and the cervical spine (at least) should be immobilized. To our knowledge, the scientific literature and current guidelines do not offer detailed recommendations on the extrication of injured patients. Thus, the aim of the current study is to compare the effectiveness of spinal stabilization during various out-of-hospital extrication procedures.
This is an explorative, biomechanical analysis of spine motion during different extrication procedures on an example patient. Movement of the cervical spine was measured using a wireless human motion tracker. Movement of the thoracic and lumbar spine was quantified with 12 strain gauge sensors, which were positioned paravertebrally on both sites along the thoracic and lumbar spine. To interpret angular movement, a motionscore was developed based on newly defined axioms on the biomechanics of the injured spine.
Self-extrication showed the least spinal movement (overall motionscore sum = 667). Movement in the cervical spine could further be reduced by applying a cervical collar. The extrication by a rescue boa showed comparable results in overall spinal movement compared to the traditional extrication via spineboard (overall motionscore sum = 1862vs. 1743). Especially in the cervical spine, the spinal movement was reduced (motionscore sum = 339 vs. 595). However, the thoracic spine movement was increased (motionscore sum = 812 vs. 432).
In case of a suspected cervical spine injury, guided self-extrication seems to be the best option. If the patient is not able to perform self-extrication, using a rescue boa might reduce cervical spinal movement compared to the traditional extrication procedure. Since promising results are shown in the case of extrication using a patient transfer sheet that has already been placed below the driver, future developments should focus on novel vehicle seats that already include an extrication device.
道路交通碰撞后患者的救援是急诊医学中的基本程序之一。因此，救援是全球大多数紧急医疗服务机构经常执行的程序。适当的救援程序取决于患者的当前状况和伴随的伤害。快速救援应在几分钟内完成，并应固定颈椎（至少）。据我们所知，科学文献和现行指南并没有提供关于受伤患者救援的详细建议。因此，本研究的目的是比较不同院外救援程序中脊柱稳定的效果。
这是对一名示例患者进行的不同救援程序中脊柱运动的探索性生物力学分析。使用无线人体运动跟踪器测量颈椎运动。使用 12 个应变片传感器测量胸椎和腰椎的运动，这些传感器沿胸椎和腰椎的两侧椎旁定位。为了解释角运动，根据受伤脊柱生物力学的新定义轴，开发了一个运动评分。
自救显示出最小的脊柱运动（总运动评分和=667）。通过使用颈托可以进一步减少颈椎运动。使用救援带进行救援与传统的使用脊柱板进行救援相比，整体脊柱运动的结果相当（总运动评分和=1862 与 1743）。特别是在颈椎，脊柱运动减少（运动评分和=339 与 595）。然而，胸椎运动增加（运动评分和=812 与 432）。
在怀疑颈椎损伤的情况下，引导自救似乎是最佳选择。如果患者无法自救，使用救援带可能会比传统的救援程序减少颈椎运动。由于在已经放置在驾驶员下方的患者转移单上进行救援的结果显示出有希望的结果，因此未来的发展应侧重于已经包括救援装置的新型车辆座椅。
