Liengswangwong Wijittra, Lertviboonluk Natcha, Yuksen Chaiyaporn, Laksanamapune Thanakorn, Limroongreungrat Weerawat, Mongkolpichayaruk Atipong, Tharawadeepimuk Kittichai, Jamkrajang Parunchaya, Sook-Oum Prayoot, Watcharakitpaisan Sorawich
Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand.
College of Sports Science and Technology, Mahidol University, Thailand.
Arch Acad Emerg Med. 2023 Jun 12;11(1):e44. doi: 10.22037/aaem.v11i1.2036. eCollection 2023.
Inadequate spinal motion restriction in patients suffering from spinal injuries could lead to further neurological damage, ultimately worsening their prognosis. This study aimed to investigate the efficacy of long spinal boards (LSB), ske stretcher, and vacuum mattress for cervical spine immobilization during transportation of patients by measuring the angular motion of the cervical spine following lifting, transferring, and tilting.
We conducted an experimental study using a box of three randomizations and crossover designs without a washout period effect for the long spinal board, sked stretcher, and vacuum mattress. We concealed the randomization with sequentially numbered, opaque, sealed envelopes (SNOSE). Kinematic data were collected using eight optoelectronic cameras at 200 Hz (BTS Bioengineering, Milan, Italy) in triangular planes (lateral bending, flexion-extension, and axial rotation) while performing all three motions (static lift-hold, transfer, and 90° tilt).
12 cases (7 males and 5 females) with the mean age of 20 ± 3.03 (range: 18-28) years were studied. The three highest angular motions were observed in the axial rotation plane during patient's tilting under immobilization on all devices (Vacuum mattress having the highest value of 99.01±8.93, followed by the LSB at 89.89±34.35 and the sked stretcher at 86.30±7.73 degrees). During patient lifting, a higher angular motion was observed with vacuum mattress immobilization in flexion extension (Coefficient = 4.45; 95%CI: 0.46 - 8.45; p =0.029) and axial rotation (Coefficient = 3.70; 95%CI: 0.58 - 6.81; p =0.020) planes. During patient transfer, a higher angular motion was observed with sked stretcher in the flexion-extension plane (Coefficient = 2.98; 95%CI: 0.11 - 5.84; p = 0.042). During patient tilting to 90 degrees, a higher angular motion was observed with vacuum mattress immobilization in lateral bending (Coefficient = -4.08; 95%CI: -7.68 - -0.48; p = 0.026) for the vacuum mattress.
Based on the finding of the present study, patients on the vacuum mattress experience significantly higher angular motion in flexion extension and axial rotation during lifting, as well as lateral bending during 90-degree tilting. In addition, patients on the sked stretcher showed significantly higher angular motion in flexion-extension during the transferring. However, the predictive margins for immobilization across all devices did not demonstrate clinically significant differences among the three immobilization devices.
脊柱损伤患者的脊柱运动限制不足可能导致进一步的神经损伤，最终恶化其预后。本研究旨在通过测量患者在抬起、转移和倾斜后颈椎的角运动，研究长脊柱板（LSB）、斯基德担架和真空床垫在患者转运过程中对颈椎固定的有效性。
我们进行了一项实验研究，采用三因素随机化和交叉设计，对长脊柱板、斯基德担架和真空床垫无洗脱期效应。我们使用顺序编号、不透明、密封的信封（SNOSE）隐藏随机化。在执行所有三种动作（静态抬起保持、转移和90°倾斜）时，使用八个光电摄像头以200Hz的频率（BTS生物工程公司，意大利米兰）在三角平面（侧弯、屈伸和轴向旋转）收集运动学数据。
研究了12例患者（7例男性和5例女性），平均年龄为20±3.03岁（范围：18 - 28岁）。在所有设备固定患者倾斜过程中，轴向旋转平面观察到三个最高角运动（真空床垫最高值为99.01±8.93，其次是长脊柱板为89.89±34.35，斯基德担架为86.30±7.73度）。在患者抬起过程中，真空床垫固定在屈伸（系数 = 4.45；95%CI：0.46 - 8.45；p = 0.029）和轴向旋转（系数 = 3.70；95%CI：0.58 - 6.81；p = 0.020）平面观察到更高的角运动。在患者转移过程中，斯基德担架在屈伸平面观察到更高的角运动（系数 = 2.98；95%CI：0.11 - 5.84；p = 0.042）。在患者倾斜至90度时，真空床垫固定在侧弯时观察到更高的角运动（系数 = -4.08；95%CI：-7.68 - -0.48；p = 0.026）。
基于本研究结果，真空床垫上的患者在抬起过程中的屈伸和轴向旋转以及90度倾斜过程中的侧弯中经历了明显更高的角运动。此外，斯基德担架上的患者在转移过程中的屈伸中显示出明显更高的角运动。然而，所有设备固定的预测边缘在三种固定设备之间未显示出临床显著差异。
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