Kennedy F R, Gonzalez P, Beitler A, Sterling-Scott R, Fleming A W
Department of Surgery, Martin Luther King, Jr./Charles R. Drew University, School of Medicine and Science, Los Angeles, Calif.
South Med J. 1994 Jun;87(6):621-3. doi: 10.1097/00007611-199406000-00008.
Cervical spine immobilization is standard during the early stages of prehospital and hospital care of patients with blunt head injury. However, the need for cervical spine immobilization in patients with gunshot wounds to the head has not been addressed. To determine the incidence and types of cervical spine injury in this group, we retrospectively examined the records of 308 consecutive patients who had computed tomographic (CT) scans of the head to evaluate brain injury after gunshot wounds. Of the 266 patients with data adequate for review, 157 (59%) had a complete lateral x-ray film of the cervical spine. Of these 157, 105 had wounds limited to the calvaria, and none had cervical spine injury. Of 52 patients with complete lateral x-ray films and wounds not limited to the calvaria, 5 (10%) had cervical spine or spinal cord injury. Of the 192 patients who had CT-proven intracranial injury, 86 (45%) required immediate intubation before x-ray films were obtained, and 67 (35%) died. We conclude that cervical spine immobilization may not be required during endotracheal intubation of brain-injured gunshot victims with wounds limited to the calvaria.
在钝性头部损伤患者的院前和院内护理早期，颈椎固定是标准操作。然而，头部枪伤患者颈椎固定的必要性尚未得到探讨。为了确定该组患者颈椎损伤的发生率和类型，我们回顾性研究了308例连续接受头部计算机断层扫描（CT）以评估枪伤后脑损伤患者的记录。在266例有足够数据可供审查的患者中，157例（59%）有完整的颈椎侧位X线片。在这157例患者中，105例伤口仅限于颅骨，无一例有颈椎损伤。在52例有完整颈椎侧位X线片且伤口不限于颅骨的患者中，5例（10%）有颈椎或脊髓损伤。在192例经CT证实有颅内损伤的患者中，86例（45%）在获得X线片之前需要立即插管，67例（35%）死亡。我们得出结论，对于伤口仅限于颅骨的脑损伤枪伤受害者，气管插管期间可能不需要颈椎固定。
