Hauswald M, Ong G, Tandberg D, Omar Z
Department of Emergency Medicine, University of New Mexico, School of Medicine, Albuquerque 87131-5246, USA.
Acad Emerg Med. 1998 Mar;5(3):214-9. doi: 10.1111/j.1553-2712.1998.tb02615.x.
To examine the effect of emergency immobilization on neurologic outcome of patients who have blunt traumatic spinal injuries.
A 5-year retrospective chart review was carried out at 2 university hospitals. All patients with acute blunt traumatic spinal or spinal cord injuries transported directly from the injury site to the hospital were entered. None of the 120 patients seen at the University of Malaya had spinal immobilization during transport, whereas all 334 patients seen at the University of New Mexico did. The 2 hospitals were comparable in physician training and clinical resources. Neurologic injuries were assigned to 2 categories, disabling or not disabling, by 2 physicians acting independently and blinded to the hospital of origin. Data were analyzed using multivariate logistic regression, with hospital location, patient age, gender, anatomic level of injury, and injury mechanism serving as explanatory variables.
There was less neurologic disability in the unimmobilized Malaysian patients (OR 2.03; 95% CI 1.03-3.99; p = 0.04). This corresponds to a <2% chance that immobilization has any beneficial effect. Results were similar when the analysis was limited to patients with cervical injuries (OR 1.52; 95% CI 0.64-3.62; p = 0.34).
Out-of-hospital immobilization has little or no effect on neurologic outcome in patients with blunt spinal injuries.
探讨紧急固定对钝性创伤性脊柱损伤患者神经功能转归的影响。
在两家大学医院进行了一项为期5年的回顾性病历审查。纳入所有从受伤现场直接转运至医院的急性钝性创伤性脊柱或脊髓损伤患者。在马来亚大学就诊的120例患者在转运过程中均未进行脊柱固定，而在新墨西哥大学就诊的334例患者均进行了脊柱固定。两家医院在医师培训和临床资源方面具有可比性。由两名独立且对患者来源医院不知情的医师将神经损伤分为致残或非致残两类。采用多因素logistic回归分析数据，将医院位置、患者年龄、性别、损伤解剖平面和损伤机制作为解释变量。
未进行固定的马来西亚患者神经功能障碍较少（比值比2.03；95%置信区间1.03 - 3.99；p = 0.04）。这意味着固定产生有益效果的可能性小于2%。当分析仅限于颈椎损伤患者时，结果相似（比值比1.52；95%置信区间0.64 - 3.62；p = 0.34）。
院外固定对钝性脊柱损伤患者的神经功能转归几乎没有影响。
