Milland Kristopher, Al-Dhahir Mohammed A.
University of Tennessee
Independent Medical Professional – Preparing for U.S. Medical Licensure
Blunt traumatic injuries are the leading cause of spinal cord injuries in the United States, with an annual incidence of approximately 54 cases per million population and about 3% of all blunt trauma admissions to the hospital. Although spinal cord injuries represent only a small percentage of blunt trauma injuries, they are among the largest contributors to morbidity and mortality. As a result, in 1971, the American Academy of Orthopedic Surgeons proposed using a cervical collar and a long spine board for spinal motion restriction for patients with suspected spinal injuries, which was based entirely on the mechanism of injury. At the time, this was based on consensus rather than evidence. In the decades since spinal motion restriction, using a cervical collar and long spine board has become the standard in prehospital care. It can be found in several guidelines, including the Advanced Trauma Life Support (ATLS) and Prehospital Trauma Life Support (PHTLS) guidelines. Despite their widespread use, the efficacy of these practices has been called into question. In one international study comparing those who underwent spinal motion restriction to those who did not, the study found that those who did not receive routine care with spinal motion restriction had fewer neurologic injuries with disability. However, it should be noted that these patients were not matched for the severity of the injury. Using healthy young volunteers, another study looked at lateral spine motion on a long spine board compared to a stretcher mattress and found that the long spine board allowed the greater lateral motion. In 2019, a retrospective, observational, multi-agency prehospital study examined whether or not there was a change in spinal cord injuries after implementing an EMS protocol that limited spinal precautions to only those with significant risk factors or abnormal exam findings and found that there was no difference in the incidence of spinal cord injuries. There are currently no high-level randomized control trials to either support or refute the use of spinal motion restriction. It is unlikely there will be a patient to volunteer for a study that could result in permanent paralysis violates current ethical guidelines. As a result of these and other studies, newer guidelines recommend limiting the use of long spine board spinal motion restriction to those with a concerning mechanism of injury or concerning signs or symptoms as described later in this article and limiting the duration that a patient spends immobilized.
在美国，钝性创伤是脊髓损伤的主要原因，年发病率约为每百万人口54例，约占所有钝性创伤住院病例的3%。尽管脊髓损伤在钝性创伤中所占比例很小，但却是发病率和死亡率的主要促成因素之一。因此，1971年，美国矫形外科医师学会提议对疑似脊柱损伤的患者使用颈托和长脊柱板来限制脊柱活动，这完全是基于损伤机制。当时，这是基于共识而非证据。自限制脊柱活动以来的几十年里，使用颈托和长脊柱板已成为院前护理的标准做法。它出现在多项指南中，包括高级创伤生命支持（ATLS）和院前创伤生命支持（PHTLS）指南。尽管它们被广泛使用，但这些做法的有效性受到了质疑。在一项国际研究中，将接受脊柱活动限制的患者与未接受的患者进行比较，研究发现，未接受常规脊柱活动限制护理的患者神经损伤伴残疾的情况较少。然而，应该指出的是，这些患者的损伤严重程度并不匹配。另一项研究使用健康的年轻志愿者，比较了长脊柱板与担架床垫上的脊柱侧方活动情况，发现长脊柱板允许更大的侧方活动。2019年，一项回顾性、观察性、多机构院前研究调查了实施一项急救医疗服务（EMS）方案后脊髓损伤是否有变化，该方案将脊柱预防措施仅限于那些有重大风险因素或异常检查结果的患者，结果发现脊髓损伤的发生率没有差异。目前没有高水平的随机对照试验来支持或反驳脊柱活动限制的使用。不太可能有患者自愿参加一项可能导致永久性瘫痪的研究，因为这违反了现行的伦理准则。由于这些研究和其他研究，更新后的指南建议将长脊柱板脊柱活动限制的使用限于具有本文后面所述的可疑损伤机制或可疑体征或症状的患者，并限制患者固定的时间。
