Prehosp Emerg Care. 2021 Jan-Feb;25(1):117-124. doi: 10.1080/10903127.2020.1727591. Epub 2020 Mar 18.
Spinal precautions are intended to limit motion of potentially unstable spinal segments. The efficacy of various treatment approaches for motion restriction in the cervical spine has been rigorously investigated using healthy volunteers and, to a lesser extent, cadaver samples. No previous studies have objectively measured this motion in trauma patients with potential spine injuries during prehospital care. The purpose of this study was to characterize head-neck (H-N) kinematics in a sample of trauma patients receiving spinal precautions in the field. This was a prospective observational study of trauma patients in the prehospital setting. Trauma patients meeting criteria for spinal precautions were eligible for inclusion. Participants received usual care, consisting of either a long backboard, cervical collar, and head blocks (BC) or a cervical collar only (CO), and behavior was categorized as compliant (C) or non-compliant (N). Three inertial measurement units (IMUs), placed on each participant's forehead, sternum, and stretcher, yielded data on H-N motion. Outcomes were described in terms of H-N displacement and acceleration, including single- and multi-planar values, root mean square (RMS), and bouts of continuous motion above pre-determined thresholds. Data were analyzed to compare H-N motion by phase of prehospital care, as well as treatment type and patient behavior.
Substantial single- and multi-plane H-N motion was observed among all participants. Maximum single-plane displacements were between 11.3 ± 3.0 degrees (rotation) and 19.0 ± 16.6 degrees (flexion-extension). Maximum multi-plane displacements averaged 31.2 ± 7.2 degrees (range: 7.2 to 82.1 degrees). Maximum multi-plane acceleration averaged 5.8 ± 1.4 m/s (range: 1.2 to 19.9 m/s). There were no significant differences among participants between prehospital phase and treatment type. Non-compliant participants showed significantly more motion than compliant participants. Among actual patients, movement appears to be greater than previously recorded in simulation studies, and to be associated with patient behavior. Miniature IMUs are a feasible approach to field-based measurement of H-N kinematics in trauma patients. Future research should evaluate the effects of patient compliance, treatment, and phase of care using larger samples. spinal immobilization; cervical spine; cervical collar; long backboard.
脊柱预防措施旨在限制潜在不稳定脊柱节段的运动。已经使用健康志愿者以及在较小程度上使用尸体样本对各种限制颈椎运动的治疗方法的疗效进行了严格的研究。以前没有研究在接受院前护理的潜在脊柱损伤的创伤患者中客观测量过这种运动。本研究的目的是描述在接受现场脊柱预防措施的创伤患者中头颈部（H-N）运动学的特征。这是一项对院前环境中创伤患者的前瞻性观察研究。符合脊柱预防措施标准的创伤患者有资格入组。参与者接受常规护理，包括长背板、颈圈和头部固定器（BC）或仅颈圈（CO），行为分为依从（C）或不依从（N）。三个惯性测量单元（IMU）分别放置在每个参与者的额头、胸骨和担架上，产生 H-N 运动的数据。结果以 H-N 位移和加速度来描述，包括单平面和多平面值、均方根（RMS）和超过预定阈值的连续运动发作。通过院前护理阶段、治疗类型和患者行为来比较 H-N 运动。
所有参与者均观察到明显的单平面和多平面 H-N 运动。最大单平面位移为 11.3±3.0 度（旋转）和 19.0±16.6 度（屈伸）之间。平均最大多平面位移为 31.2±7.2 度（范围：7.2 至 82.1 度）。最大多平面加速度平均为 5.8±1.4 m/s（范围：1.2 至 19.9 m/s）。参与者在院前阶段和治疗类型之间没有显著差异。不依从的参与者比依从的参与者表现出明显更多的运动。在实际患者中，运动似乎比模拟研究中记录的更大，并与患者行为有关。微型 IMU 是一种可行的方法，可以在创伤患者中进行基于现场的 H-N 运动学测量。未来的研究应该使用更大的样本量评估患者依从性、治疗和护理阶段的影响。脊柱固定；颈椎；颈圈；长背板。
