Center for Public Health and Health Services Research, University Hospital of Tübingen, and German Red Cross Emergency Services Reutlingen; Institute of Clinical Epidemiology and Applied Biometry, University Hospital of Tübingen; Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Federal Armed Forces Hospital of Ulm; Department for Orthopedic Surgery, Trauma and Sports Traumatology - Hand and Plastic Surgery, Musculoskeletal Center Neuwied, Marienhaus Hospital Neuwied; Department of Trauma and Orthopedic Surgery, BG Trauma Center, Frankfurt am Main; Department for Anesthesiology, Intensive Care Medicine, Emergency Medicine, Pain Therapy and Palliative Care, am Steinenberg Hospital, Reutlingen.
Dtsch Arztebl Int. 2022 Nov 4;119(44):753-758. doi: 10.3238/arztebl.m2022.0291.
Spinal injuries are difficult injuries to assess yet can be associated with significant neurological damage. To avoid secondary damage, immobilization is considered state of the art trauma care. The indication for spinal immobilization must be assessed, however, for potential complications as well as its advantages and disadvantages.
This systematic review addressing the question of the correct indication for spinal immobilization in trauma patients was compiled on the basis of our previously published analysis of possible predictors from the Trauma Registry of the German Society for Trauma Surgery. A Delphi procedure was then used to develop suggestions for action regarding immobilization based on the results of this review.
The search of the literature yielded 576 publications. The 24 publications included in the qualitative analysis report of 2 228 076 patients. A decision tool for spinal immobilization in prehospital trauma care was developed (Immo traffic light system) based on the results of the Delphi procedure. According to this system, severely injured patients with blunt trauma, severe traumatic brain injury, peripheral neurological symptoms, or spinal pain requiring treatment should be immobilized. Patients with a statistically increased risk of spinal injury as a result of the four cardinal features (fall >3m, severe trunk injury, supra clavicular injury, seniority [age >65 years]) should only have their spinal motion restricted after weighing up the pros and cons. Isolated penetrating trunk injuries should not be immobilized.
High-quality studies demonstrating the benefit of prehospital spinal immobilization are still lacking. Decision tools such as the Immo traffic light system can help weigh up the pros and cons of immobilization.
脊柱损伤难以评估，但可能导致严重的神经损伤。为避免继发性损伤，脊柱固定被认为是创伤急救的最新方法。然而，必须评估脊柱固定的适应证，以了解其潜在并发症以及优缺点。
本系统评价基于我们之前对德国创伤外科学会创伤登记处可能预测因素的分析，针对创伤患者正确的脊柱固定适应证这一问题进行了编译。然后，使用 Delphi 程序根据该综述的结果，就固定的适应证提出行动建议。
文献检索共获得 576 篇文献。24 篇纳入的文献报告了 2 228 076 例患者。根据 Delphi 程序的结果，开发了一种用于院前创伤急救中脊柱固定的决策工具（Immo 交通信号灯系统）。根据该系统，应固定钝性创伤、严重创伤性脑损伤、周围神经症状或需要治疗的脊柱疼痛的严重受伤患者。由于四个主要特征（坠落>3m、严重躯干损伤、锁骨以上损伤、高龄[年龄>65 岁]）而导致脊柱损伤风险统计学增加的患者，应权衡利弊后限制其脊柱活动。孤立性穿透性躯干损伤不应固定。
仍缺乏证明院前脊柱固定有益的高质量研究。决策工具（如 Immo 交通信号灯系统）可帮助权衡利弊。
