Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH 43202, USA.
Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43202, USA.
Mil Med. 2023 Aug 29;188(9-10):e2987-e2991. doi: 10.1093/milmed/usad081.
Cervical spine immobilization in a low-resource environment is difficult secondary to limited equipment, prolonged transportation, and secondary complications. A structural aluminum malleable (SAM) splint is commonly utilized because of its availability and multipurpose intention. A one-step spray-on foam immobilization technique (Fast Cast) has been shown to be effective in lower-extremity splinting. The aim of this study was to demonstrate the ability of the Fast Cast to effectively immobilize the cervical spine in a head-to-head comparison against the SAM splint. We hypothesized that there would be no difference in surgeon scoring between Fast Cast and SAM splints for the immobilization of the cervical spine.
This was a cadaveric experimental comparative study that compared a SAM splint versus Fast Cast for the immobilization of an unstable cervical spine. Each of the three cadaveric specimens had a corpectomy without fixation performed. A board-certified emergency medicine physician specialized in disaster medicine performed all SAM immobilizations. An orthopedic surgeon performed Fast Cast immobilizations. Each method of immobilization was done on each cadaver. Lateral fluoroscopic imaging was taken before and after immobilization and after log roll/gravity stress. Five board-certified orthopedic surgeons served as graders to independently score each splint. A 5-point Likert scale based on 10 splinting criteria (50 total points possible) was utilized to evaluate cervical spine immobilization. The lead statistical analyst was blinded to the immobilization groups. The statistical significance was assessed via a Wilcoxon signed-rank test and chi-square Fisher's exact test with significance between groups set at α < .05. Inter-rater reliability of the Likert scale results was assessed with the interclass correlation coefficient.
Inter-rater reliability for the current Likert scale in the evaluation of cervical spine stabilization was good (interclass correlation coefficient = 0.76). For the cumulative Likert scale score, Fast Cast (32 [28-34]) exhibited a higher total score than SAM (44 [42-47]; P < .01). Likewise, Fast Cast exhibited a greater likelihood of higher Likert scores within each individual question as compared to SAM (P ≤ 0.04). In 100% of cases, raters indicated that Fast Cast passed the gravity stress examination without intrinsic loss of reduction or splinting material, whereas 33% of SAM passed (P < .01). In 100% of cases, raters indicated that Fast Cast passed the initial radiographic alignment following immobilization, whereas 66% of SAM passed (P = .04). In 100% of cases, raters indicated that Fast Cast passed radiographic alignment after the gravity stress examination, whereas 47% of SAM passed (P < .01).
The Fast Cast exceeded our expectations and was shown to be rated not equivalent but superior to SAM splint immobilization for the cervical spine. This has significant clinical implications as the single-step spray-on foam is easy to transport and has multifaceted applications. It also eliminates pressure points and circumferential wrapping and obstruction to airway/vascular access while immobilizing the cervical spine and allowing for radiographic examination. Further studies are needed for human use and application.
由于设备有限、运输时间长和继发并发症，在资源匮乏的环境中对颈椎进行固定是很困难的。由于其可用性和多用途性，结构铝合金可塑性（SAM）夹板通常被使用。一步喷涂泡沫固定技术（Fast Cast）已被证明在下肢夹板固定中有效。本研究旨在通过与 SAM 夹板的头对头比较，证明 Fast Cast 有效固定颈椎的能力。我们假设在固定颈椎方面，Fast Cast 和 SAM 夹板在外科医生评分上没有差异。
这是一项比较不稳定颈椎的 SAM 夹板与 Fast Cast 的尸体实验性比较研究。每个尸体标本都进行了椎体切除术但未固定。一名经过认证的急诊医学医师专门从事灾难医学，对所有 SAM 固定进行操作。一名骨科医生进行 Fast Cast 固定。每个固定方法都在每个尸体上进行。在固定前后和滚轴重力试验后进行侧位荧光透视成像。5 名经过认证的骨科医生作为评分员，对每个夹板进行独立评分。使用基于 10 个夹板标准的 5 分李克特量表（总 50 分）评估颈椎固定。主要统计分析员对固定组进行盲法。通过 Wilcoxon 符号秩检验和卡方 Fisher 精确检验评估统计学意义，组间差异显著设置为α<0.05。采用组内相关系数评估 Likert 量表结果的组内信度。
当前 Likert 量表在评估颈椎稳定方面的组内信度良好（组内相关系数=0.76）。对于累积 Likert 量表评分，Fast Cast（32 [28-34]）的总分高于 SAM（44 [42-47]；P<0.01）。同样，Fast Cast 在每个单独问题中表现出更高 Likert 评分的可能性更高，而 SAM 则较低（P≤0.04）。在 100%的情况下，评分者表示 Fast Cast 在没有内在复位丢失或夹板材料丢失的情况下通过了重力应激检查，而 33%的 SAM 通过（P<0.01）。在 100%的情况下，评分者表示 Fast Cast 在固定后通过了初始影像学对齐，而 66%的 SAM 通过（P=0.04）。在 100%的情况下，评分者表示 Fast Cast 在重力应激检查后通过了影像学对齐，而 47%的 SAM 通过（P<0.01）。
Fast Cast 超出了我们的预期，其结果表明其固定颈椎的效果优于 SAM 夹板固定，而不是等效。这具有重要的临床意义，因为这种一步喷涂泡沫易于运输，具有多方面的应用。它还消除了压力点和环形包扎以及对颈椎固定时的气道/血管通路的阻塞，并允许进行影像学检查。需要进一步的人体使用和应用研究。
