Moeri Michaël, Rothenfluh Dominique A, Laux Christoph J, Dominguez Dennis E
Division of Orthopaedic and Trauma Surgery, Geneva University Hospitals, Switzerland.
Oxford University Hospitals NHS Foundation Trust, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK.
EFORT Open Rev. 2020 Apr 6;5(4):253-259. doi: 10.1302/2058-5241.5.190047. eCollection 2020 May.
No definite consensus exists for the clearance of the cervical spine (C-spine) after blunt trauma, despite many validated algorithms, recommendations and guidelines. We intend to answer the most relevant questions with which physicians are confronted when clearing C-spines after blunt trauma in emergency departments (EDs). To exclude significant C-spine injuries we designed an algorithm to be compatible with clinical practice, to simplify patient management and avoid unrewarding evaluation.We conducted an exploratory PubMed search including articles published from January 2000 to October 2018. Keywords used were "cervical spine", "injury", "clearance", "Canadian C-spine Rule", "CCR" and "national emergency x-radiography utilization study". Clinical and experimental studies were included in a detailed review.We based our literature review on 33 articles. While answering fundamental triage questions from daily clinical practice, the current literature is discussed in detail. We designed an algorithm for the C-spine clearance suitable for any trauma centre with a high-quality multiplanar reconstruction computerized tomography (CT) scan continuously available.The high sensitivity of the Canadian C-spine Rule (CCR) prevents missing C-spine injuries while limiting the amount of unnecessary radiologic examinations. Plain radiographs were fully abandoned for C-spine clearance. A negative CT scan is sufficient to clear the majority of C-spine injuries and allows for collar removal. In case of motor symptoms or radio-clinical discrepancy, the advice of a specialized spine surgeon must be requested. Magnetic resonance imaging must not be routinely used. Neck pain despite negative imaging is not a reason to delay removal of stiff cervical collars. Cite this article: 2020;5:253-259. DOI: 10.1302/2058-5241.5.190047.
尽管有许多经过验证的算法、建议和指南，但对于钝性创伤后颈椎（C 脊柱）的评估尚无明确的共识。我们旨在回答急诊科（ED）医生在钝性创伤后评估 C 脊柱时面临的最相关问题。为了排除严重的 C 脊柱损伤，我们设计了一种与临床实践兼容的算法，以简化患者管理并避免无意义的评估。我们在 PubMed 上进行了探索性搜索，包括 2000 年 1 月至 2018 年 10 月发表的文章。使用的关键词是“颈椎”、“损伤”、“评估”、“加拿大 C 脊柱规则”、“CCR”和“国家急诊 X 线摄影利用研究”。临床和实验研究纳入详细综述。我们的文献综述基于 33 篇文章。在回答日常临床实践中的基本分诊问题时，对当前文献进行了详细讨论。我们设计了一种适用于任何拥有连续可用的高质量多平面重建计算机断层扫描（CT）的创伤中心的 C 脊柱评估算法。加拿大 C 脊柱规则（CCR）的高敏感性可防止漏诊 C 脊柱损伤，同时限制不必要的放射学检查数量。C 脊柱评估完全放弃了平片。阴性 CT 扫描足以排除大多数 C 脊柱损伤并允许去除颈托。如果出现运动症状或放射学与临床不符，必须征求专业脊柱外科医生的意见。磁共振成像不应常规使用。尽管影像学检查阴性但颈部疼痛不是延迟去除硬颈托的理由。引用本文：2020；5：253 - 259。DOI：10.1302/2058 - 5241.5.190047。
