Klinik Für Unfallchirurgie Und Orthopädie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
Klinik Für Anästhesiologie, Stiftung Krankenhaus Bethanien, Bethanienstraße 21, 47441, Moers, Germany.
Eur J Trauma Emerg Surg. 2022 Apr;48(2):1389-1399. doi: 10.1007/s00068-021-01702-3. Epub 2021 May 25.
For trauma surgeons, the evaluation of the stability of the upper cervical spine may be demanding. The aim of this study was to develop a protocol for decision-making on upper cervical spine stability in trauma patients based on established parameters obtained by CT imaging as well as testing the protocol by having it applied by trauma surgeons.
A structured literature search on upper cervical spine stability was performed. The best evaluated instability criteria in CT imaging were determined. Based on these parameters a protocol for stability evaluation of the injured upper cervical spine was developed. A first application testing was performed. In addition to the assessment of instability, the time required for the assessment was analyzed.
A protocol for CT-based stability evaluation of the injured upper cervical spine based on the current literature was developed and displayed in a flow chart. Testing of the protocol found the stability of the cervical spine was correctly assessed in 55 of 56 evaluations (98.2%). In one test run, a stable upper cervical spine was judged to be unstable. Further analysis showed that this case was based on a measurement error. The assessment time of CT-images decreased significantly during repeat application of the protocol (p < 0.0001), from 336 ± 108 s (first case) to 180 ± 30 s (fourth case).
The protocol can be applied quickly and safely by non-specialized trauma surgeons. Thus, the protocol can support the decision-making process in CT-based evaluation of the stability of the injured upper cervical spine.
对于创伤外科医生来说，评估上颈椎的稳定性可能具有挑战性。本研究旨在制定一种基于 CT 影像学获得的既定参数的上颈椎稳定性决策方案，并通过创伤外科医生的应用来检验该方案。
对颈椎上段稳定性进行了系统的文献检索。确定了在 CT 成像中评价最不稳定的标准。基于这些参数，制定了一个用于评估受伤上颈椎稳定性的方案。进行了首次应用测试。除了评估不稳定性外，还分析了评估所需的时间。
根据现有文献制定了一个基于 CT 的上颈椎损伤稳定性评估方案，并以流程图的形式展示。对方案的测试发现，在 56 次评估中有 55 次（98.2%）正确评估了颈椎的稳定性。在一次测试中，判断稳定的上颈椎不稳定。进一步分析表明，这种情况是基于测量误差。重复应用方案时，CT 图像的评估时间显著减少（p < 0.0001），从第一次评估的 336 ± 108 s 减少到第四次评估的 180 ± 30 s。
非专业创伤外科医生可以快速、安全地应用该方案。因此，该方案可以支持基于 CT 评估受伤上颈椎稳定性的决策过程。
