Comparison of the Bullard and Macintosh Laryngoscopes for Endotracheal Intubation of Patients with a Potential Cervical Spine Injury

Background: In the emergency trauma situation, in-line stabilization (ILS) of the cervical spine is used to reduce head and neck extension during laryngoscopy. The Bullard laryngoscope may result in less cervical spine movement than the Macintosh laryngoscope. The aim of this study was to compare cervical spine extension (measured radiographically) and time to intubation with the Bullard and Macintosh laryngoscopes during a simulated emergency with cervical spine precautions taken.

Methods: Twenty-nine patients requiring general anesthesia and endotracheal intubation were studied. Patients were placed on a rigid board and anesthesia was induced. Laryngoscopy was performed on four occasions: with the Bullard and Macintosh laryngoscope both with and without manual ILS. Cricoid pressure was applied with ILS. To determine cervical spine extension, radiographs were exposed before and during laryngoscopy. Times to intubation and grade view of the larynx were also compared.

Results: Cervical spine extension (occiput-C5) was greatest with the Macintosh laryngoscope (25.9 [degree sign] +/- 2.8 [degree sign]). Extension was reduced when using the Macintosh laryngoscope with ILS (12.9 +/- 2.1 [degree sign]) and the Bullard laryngoscope without stabilization (12.6 +/- 1.8 [degree sign]; P < 0.05). Times to intubation were similar for the Macintosh laryngoscope with ILS (20.3 +/- 12.8 s) and for the Bullard without ILS (25.6 +/- 10.4 s). Manual ILS with the Bullard laryngoscope results in further reduction in cervical spine extension (5.6 +/- 1.5 [degree sign]) but prolongs time to intubation (40.3 +/- 19.5 s; P < 0.05).     

颈椎损伤与颈脊髓损伤的关系分析

目的分析颈椎损伤与颈脊髓损伤的关系.方法回顾性地分析了265 例颈椎损伤患者,依据Allen分类方法对其颈椎损伤类型进行分类,依据ASIA国际脊髓损伤分级标准对其脊髓损伤情况进行分级,应用统计学软件包对二者的关系进行分析.结果颈椎损伤与颈脊髓损伤之间具有一定的相关性.结论颈脊髓损伤的程度与颈椎损伤的程度之间具有一定的正相关性,根据颈椎损伤的程度可以对颈脊髓损伤的程度作出判定.     

颈椎脱位复位后继发脊髓损伤

本文报告颈椎脱位复位后继发或加重脊髓损伤14例.其中发生在颅骨牵引后9例,手法复位后4例,手术复位后1例.复位前神经功能正常5例,有轻微损伤9例,复位后发生全瘫7例,有感觉无运动7例.本文讨论了继发损伤的原因及其预防.     

强直性脊柱炎合并颈椎无骨折脱位型脊髓损伤

目的 总结强直性脊柱炎合并颈椎无骨折脱位型脊髓损伤的临床特征、诊断和手术治疗。方法 1986～2004年，笔者手术治疗累及颈椎的强直性脊柱炎合并无骨折脱位型脊髓损伤27例。结果 本组27例中椎管内韧带骨化18例，脊髓损伤的原因依次为韧带骨化所致的椎管狭窄，椎间盘损伤和椎体后骨刺及椎间不稳定。术前均为不完全性损伤，非手术治疗不提高脊髓功能。术后脊髓ASIA分级平均改善1级。后路手术椎板切除率、出血量、手术时间、术后引流量明显高于不合并强直性脊柱炎的患者。前路手术可达到骨性融合。结论 强直性脊柱炎合并颈椎无骨折脱位型脊髓损伤一般为不完全性损伤，损伤的内因依次为椎管内韧带骨化所致的椎管狭窄、椎间盘损伤、椎间骨赘和椎间不稳定。适当的手术可改善脊髓功能。手术难度大，风险高。     

Endotracheal Intubation in Patients with Cervical Spine Immobilization: A Comparison of Macintosh and Airtraq Laryngoscopes

Background: The Airtraq laryngoscope (Prodol Ltd., Vizcaya, Spain) is a novel single-use tracheal intubation device. The authors compared ease of intubation with the Airtraq and Macintosh laryngoscopes in patients with cervical spine immobilization in a randomized, controlled clinical trial.

Methods: Forty consenting patients presenting for surgery requiring tracheal intubation were randomly assigned to undergo intubation using a Macintosh (n = 20) or Airtraq (n = 20) laryngoscope. All patients were intubated by one of four anesthesiologists experienced in the use of both laryngoscopes.

Results: No significant differences in demographic or airway variables were observed between the groups. All but one patient, in the Macintosh group, were successfully intubated on the first attempt. The Airtraq reduced the duration of intubation attempts (mean +/- SD: 13.2 +/- 5.5 vs. 20.3 +/- 12.2 s), the need for additional maneuvers, and the intubation difficulty scale score (0.1 +/- 0.5 vs. 2.7 +/- 2.5). Tracheal intubation with the Airtraq caused fewer alterations in blood pressure and heart rate.     

急性下颈椎交锁型和水平脱位并脊髓损伤

目的探讨急性颈椎交锁和水平脱位并脊髓损伤的治疗方法。方法采用徒手复位和牵引相结合的方法治疗急性下颈椎交锁脱位、水平脱位伴骨折,并有不同程度脊髓和神经根受压损伤１５例病人。结果本组治疗１３例得到６～１８月的随访,平均１１月。有１２例脊柱稳定,无继发性滑脱,无显性脊柱退变和迟发脊髓损伤。脊髓和神经根恢复分优者４例、良者６例、可者２例、差者１例;优良率达８０％。结论急性下颈椎交锁及水平脱位,临床可以通过徒手复位和牵引相结合的方法,达到理想复位。结合脱水剂、微血管扩张剂、糖皮质激素和神经介质等药物应用,促进脊髓神经组织恢复。     

无骨折脱位型颈髓损伤的手术治疗分析

目的总结分析无骨折脱位型颈髓损伤患者的手术疗效。方法自2010年1月至2013年12月,对30例采用手术治疗的无骨折脱位型颈髓损伤患者的临床资料进行回顾性分析,并比较手术前后JOA评分。结果术前JOA评分5.1±1.6,术后随访时为11.8±1.7,差异有显著统计学意义(P0.01),JOA改善率为56.3%。结论手术治疗无骨折脱位型颈髓损伤的基本原则是早期减压与稳定,根据患者的影像学特点,有针对性地选择手术方式,可获得较满意的疗效。     

经皮扩张气管切开术在重度颈髓损伤颈椎前路或前后路联合手术后人工气道中的应用

目的探讨颈椎前路和颈椎前后路联合颈椎切开复位内固定手术后行经皮扩张气管切开术的安全性。方法回顾性分析2012年1月～2013年3月颈脊髓损伤17例,行颈前路（12例）或颈前后路（5例）切开复位内固定手术,术后5—11d行经皮扩张气管切开术。结果17例经皮扩张气管切开术均过程顺利,无颈前部重要器官损伤、术后局部大量出血、造瘘区域感染、颈前路手术切口及切口深层感染。结论颈前路手术5日后行经皮扩张气管切开术是安全高效的建立人工气道的方法。     

颈椎术后脊髓缺血再灌注损伤患者的护理

对5例颈椎术患者发生脊髓缺血再灌注损伤行观察病情、冲击疗法护理、心理护理、康复训练等护理措施,结果手术顺利,4例术后出现一侧上肢感觉消失,下肢感觉迟钝,肌力明显减退.1例术后出现四肢感觉消失,肌力明显减退.5例随访四肢感觉运动正常,生活完全自理.提示有效的护理可提高患者的生活质量.     

Fractures of the Cervical Spine in Patients with Ankylosing Spondylitis

Fractures of the cervical spine in six patients suffering from ankylosing spondylitis are presented. Three patients had a hyperextension type of injury. These fractures were extremely unstable and combined with spinal cord damage. in the other cases the fracture was caused by a flexion mechanism. These fractures were stable and there was no damage to the spinal cord. Treatment modified according to the demands of the fractures is outlined.     

急性颈椎脊髓损伤的诊断和手术治疗

作者报告123例急性颈椎脊髓损伤,MRI检查46例.其中92例经颈前路于损伤节段施行减压和植骨融合术;18例行单开门椎管扩大成形加活页侧椎板间植骨术;13例行椎板切除减压,其中5例行“H”形植骨.术后随访4个月至3年.以临床症状、体征和影像检查评价其效果.结果:按照Frankle,功能分级法,术后神经功能提高一级以上者占87.2%.提示MRI对急性颈椎脊髓损伤早期诊断,预后判断及治疗方法的选择提供了可靠的依据.及时解除对脊髓的压迫,有助于神经功能的恢复.     

颈髓损伤后的神经恶化

目的：分析颈髓损伤后的病人出现神经恶化的原因,为临床治疗提供依据。方法：对２９５例颈髓损伤病人的临床资料进行分析,共有８例神经恶化,将其分为术前、术后及保守治疗３组,进一步分析引起神经恶化的原因。结果：颈椎颈髓损伤后神经恶化发生率为２．７％,恶化病人的死亡率为６２．５％。伤后５日之内手术和使用Ｈａｌｏ－Ｖｅｓｔ固定颈椎时出现的机械性不稳与神经恶化密切相关。结论：早期外科手术、Ｈａｌｏ－ｖｅｓｔ牵引     

Fractures of the Cervical Spine in Patients with Ankylosing Spondylitis

Fractures of the cervical spine in six patients suffering from ankylosing spondylitis are presented. Three patients had a hyperextension type of injury. These fractures were extremely unstable and combined with spinal cord damage. in the other cases the fracture was caused by a flexion mechanism. These fractures were stable and there was no damage to the spinal cord. Treatment modified according to the demands of the fractures is outlined.     

Nutrition in Spinal Cord Injury Patients

ABSTRACT

The nutrient intake and some indices of nutritional state were studied in 22 quadriplegic and 15 para-p?riods, the average caloric Intake recommended for comparable healthy men (2,700 kcal/day) was not achieved by 75% of the quadriplegic and 47% of the paraplegic patients. No overt signs of malnutrition or vitamin deficiencies were observed, but the average hematocrit and serum albumin levels were at the lower limits of normal. The reduced energy needs of spinal cord patients should be considered in the development of desirable nutritional norms for this patient population.     

颈椎病与急性颈脊髓损伤

从1980年10月到1994年1月我们收治41例无颈椎骨折脱位的急性颈脊髓损伤,同时在X线、CT及MRI皆有颈椎病的改变.分两组治疗方法比较,手术组皆在颅骨牵引下进行颈椎前路减压、钩椎关节增生部刮除、取自体髂骨或异体骨作椎间植骨融合术.非手术组行颅骨牵引、脱水、皮质激素、神经营养药物、中药及激光血疗,以及早期康复脊髓功能.随访1～9年4个月,平均5年1个月.手术组优14例、显效4例、差3例.非手术组优5例、显效7例、差8例.治愈显效率:前者为85.5%,后者为60%.手术组优于非手术组,P<0.05,有显著意义.治愈显效者皆在不同时间内恢复原来工作,无任何并发症.治疗的关键是选择适当的病例及严格的手术指征,熟练手术方法的技巧及术前术后的精心护理.本文对发病机理、诊治及命名亦进行了初步探讨.     

颈髓损伤后低钠血症

报告20例颈脊髓损伤患者,16例合并低钠血症,其中轻度7例,中度6例,重度3例。认为低钠的出现主要与抗利尿激素分泌紊乱而引起的水潴留,钠丢失有关。治疗要点控制水的摄入量,形成一定程度的水负平衡。并提出将其与颈脊髓损伤后出现的高温、低温等症共同命名为颈髓损伤综合征。     

颈脊髓损伤并迟发性窒息6例临床分析

目的：探讨颈脊髓严重损伤引起迟发性窒息的危险因素。方法：对6例颈脊髓严重损伤引起迟发性窒息的各种因素进行回顾性分析。65例无窒息患者作为对照组。结果：MRI显示窒息患者脊髓受累节段弥散，多累及C4节段，而对照组大多为局限性病变，一过性心动过缓和呼吸困难发生率明显高于对照组，5例发生于睡眠中，4例手术，5例死亡。结论：临床表现稳定的颈脊髓损伤患者有发生迟发窒息的危险，弥漫性脊髓损伤，损伤后出现心动过缓及呼吸困难，既使是一过性的，均应视为危险因素，夜间睡眠是危险期，应密切监护。