Bäcker Henrik C, Elias Patrick, Braun Karl F, Johnson Michael A, Turner Peter, Cunningham John
Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, USA.
Epworth Hospital Richmond, 89 Bridge Road, Richmond, VIC, 3121, USA.
Eur Spine J. 2022 Dec;31(12):3378-3391. doi: 10.1007/s00586-022-07405-6. Epub 2022 Oct 1.
Rigid cervical spine following trauma immobilization is recommended to reduce neurological disability and provide spinal stability. Soft collars have been proposed as a good alternative because of the complications related to rigid collars. The purpose of this study was to perform a systematic review on soft and rigid collars in the prehospital management of cervical trauma.
A systematic review was performed following the PRISMA guidelines. Search terms were (immobilization) AND (collar) AND ((neck) OR (cervical)) to evaluate the range of motion (ROM) and evidence of clinical outcome for soft and rigid collars.
A total of 18 studies met eligibility criteria including 2 clinical studies and 16 articles investigating the range of motion (ROM). Four hundred and ninety-six patients at a mean age of 32.5 years (SD 16.8) were included. Measurements were performed in a seated position in twelve studies. Eight articles reported the ROM without a collar, 7 with a soft collar, and 15 with a rigid collar. There was no significant difference in flexion/extension, bending and rotation following immobilization with soft collars compared to no collar. Rigid collars provided significantly higher stability compared to no collar (p < 0.005) and to soft collars in flexion/extension and rotation movements (p < 0.05). The retrospective clinical studies showed no significant differences in secondary spinal cord injuries for soft collar (0.5%) and for rigid collar (1.1%). One study, comparing immobilization without a collar compared to that with a rigid collar, found a significant difference in neurologic deficiency and supraclavicular nerve lesion.
Although rigid collars provide significant higher stability to no collar and to soft collars in flexion/ extension and rotation movements, clinical studies could not confirm a difference in neurological outcome.
II, Systematic Review.
创伤后建议使用硬质颈椎固定装置以减少神经功能障碍并提供脊柱稳定性。由于硬质颈托存在相关并发症，软质颈托被认为是一种很好的替代选择。本研究的目的是对软质和硬质颈托在颈椎创伤院前管理中的应用进行系统评价。
按照PRISMA指南进行系统评价。检索词为（固定）AND（颈托）AND（（颈部）或（颈椎）），以评估软质和硬质颈托的活动范围（ROM）及临床结局证据。
共有18项研究符合纳入标准，其中包括2项临床研究和16篇关于活动范围（ROM）的文章。纳入了496例患者，平均年龄32.5岁（标准差16.8）。12项研究在坐位进行测量。8篇文章报告了无颈托时的ROM，7篇报告了软质颈托时的ROM，15篇报告了硬质颈托时的ROM。与无颈托相比，使用软质颈托固定后在屈伸、侧弯和旋转方面无显著差异。与无颈托相比，硬质颈托在屈伸和旋转运动中提供了显著更高的稳定性（p < 0.005），与软质颈托相比也有显著差异（p < 0.05）。回顾性临床研究表明，软质颈托（0.5%）和硬质颈托（1.1%）在继发性脊髓损伤方面无显著差异。一项比较无颈托固定与硬质颈托固定的研究发现，在神经功能缺损和锁骨上神经损伤方面存在显著差异。
尽管硬质颈托在屈伸和旋转运动中比无颈托和软质颈托提供了显著更高的稳定性，但临床研究未能证实神经学结局存在差异。
II级，系统评价。
