Prehospital triage of trauma patients using the Random Forest computer algorithm

Background

Overtriage not only wastes resources but also displaces the patient from their community and causes delay of treatment for the more seriously injured. This study aimed to validate the Random Forest computer model (RFM) as means of better triaging trauma patients to level 1 trauma centers.

Methods

Adult trauma patients with “medium activation” presenting via helicopter to a level 1 trauma center from May 2007 to May 2009 were included. The “medium activation” trauma patient is alert and hemodynamically stable on scene but has either subnormal vital signs or accumulation of risk factors that may indicate a potentially serious injury. Variables included in the RFM analysis were demographics, mechanism of injury, prehospital fluid, medications, vitals, and disposition. Statistical analysis was performed via the Random Forest algorithm to compare our institutional triage rate to rates determined by the RFM.

Results

A total of 1653 patients were included in this study, of which 496 were used in the testing set of the RFM. In our testing set, 33.8% of patients brought to our level 1 trauma center could have been managed at a level 3 trauma center, and 88% of patients who required a level 1 trauma center were identified correctly. In the testing set, there was an overtriage rate of 66%, whereas using the RFM, we decreased the overtriage rate to 42% (P < 0.001). There was an undertriage rate of 8.3%.The RFM predicted patient disposition with a sensitivity of 89%, specificity of 42%, negative predictive value of 92%, and positive predictive value of 34%.

Conclusions

Although prospective validation is required, it appears that computer modeling potentially could be used to guide triage decisions, allowing both more accurate triage and more efficient use of the trauma system.     

新型脊柱固定器械的研制与临床应用

自１９８９年以来，临床应用一种新型脊柱固定器械，共６８例，其中５２例为胸腰椎骨折，１６例为椎体滑脱。经临床观察和随访，治疗效果满意。这种新型固定器械，既可行胸腰椎骨折的固定，也可行椎体滑脱的复位。根据临床需要，该器械可行压缩、撑开、成角和中立位固定。作者强调，脊柱损伤只要有手术指征，手术时机甚为重要，应早期或立即手术，有利于脊柱骨折和椎管前方骨块的复位，早期也有利于神经功能的恢复。     

Vitamin B12 Deficiency In Spinal Cord Injury: A Retrospective Study

Abstract

Background/Objective: Vitamin B12 (or cobalamin) deficiency is well known in geriatric patients, but not in those with spinal cord injury (SCI) . This retrospective study describes vitamin B1 2 deficiency in SCI.

Methods: This study utilized a retrospective chart review of patients with SCI who had received serum vitamin B1 2 testing over the last 1 0 years.

Results: Probable vitamin B1 2 deficiency was noted in 1 6 patients with SCI. Twelve patients had subnormal serum vitamin B12 levels (< 220 pg/ml), whereas 4 patients had low-normal vitamin B12 levels (< 300 pg/ml) with neurologic and/or psychiatric symptoms that improved following vitamin B1 2 replacement. Classic findings of paresthesias and numbness often were not evident; such findings likely were masked by the pre-existing sensory impairment caused by SCI. Of the 1 6 SCI patients, 7 were ambulatory; 4 of the 7 presented with deterioration of gait. In addition, 3 of the 1 6 SCI patients presented with depression and fatigue, 2 had worsening pain , 2 had worsening upper limb weakness, and 2 had memory decline. Of the 1 2 patients with subnormal serum vitamin B12 levels, 6 were asymptomatic. Classic laboratory findings of low serum vitamin B1 2 , macrocytic red blood cell indices, and megaloblastic anemia were not always present. Anem ia was identified in 7 of the 1 6 patients and macrocytic red blood cells were found in 3 of the 1 6 patients. Only 1 of the 1 6 SCI patients had a clear pathophysiologic mechanism to explain the vitamin B12 deficiency (ie, partial gastrectomy); none of the patients were vegetarian. Twelve of the SCI patients appeared to experience clinical benefits from cyanocobalamin replacement (some patients experienced more than 1 benefit), including reversal of anemia (5 patients), improved gait (4 patients), improved mood (3 patients), improved memory (2 patients), reduced pain (2 patients) , strength gain (1 patient), and reduced numbness (1 patient).

Conclusion: It is recommended that physicians consider vitamin B1 2 deficiency in their patients with SCI , particularly in those with neurologic and/ or psychiatric symptoms. These symptoms often are reversible iftreatment is initiated early.     

The Influence of Age and Gender on Rehabilitation Outcomes in Nontraumatic Spinal Cord Injury

Abstract

Study Design: Retrospective, 3-year case series.

Objective: To investigate the relationship between gender and age and a range variables in patients with nontraumatic spinal cord injury (SCI).

Setting: Tertiary medical unit specializing in rehabilitation of patients with nontraumatic SCI.

Method: Participants were a consecutive series of 70 adult inpatients with nontraumatic SCI undergoing initial rehabilitation. The variables of interest were demographic characteristics, clinical features, complications, mortality, length of stay (LOS), mobility, bladder and bowel continence, and Functional Independence Measure (FIM) scores.

Results: Men were younger than women, but the difference was not statistically significant (median 64 years vs 72.5 years, P= 0.2). There was no statistically significant relationship between age or gender and the following: American Spinal Injury Association grade, level of injury, many SCI complications, mortality, LOS, walking ability, bladder management, and fecal continence. The only SCI complication that was related to age was pressure ulcers (<65 years = 20% vs >65 years = 50%, P - 0.04). Patients discharged home were more likely to be younger (P = 0.01) and male (P = 0.03). There was a significant negative correlation between patients' age and the discharge Rasch-transformed FIM motor (Spearman's p = -0.30, P = 0.015) and cognitive (Spearman's p = -0.25, P=0.04) subscores. There were no significant relationships between gender and FIM subscale scores.

Conclusions: Gender and age do not significantly influence most aspects of rehabilitation in patients with nontraumatic SCI. Age alone should not be used as a discriminator of ability to benefit from nontraumatic SCI rehabilitation.     

Clinical Outcomes of Open-Door Laminoplasty Combined with Bilateral Lateral Mass Screw Fixation for Multi-Level Cervical Spinal Stenosis with Traumatic Cervical Instability and Spinal Cord Injury: A Retrospective Study

Objectives

The prevalence of multi-level cervical spinal stenosis complicated with traumatic cervical instability and spinal cord injury (MCSS-TCISCI) is low, and the optimal surgical approach remains unclear. Open-door laminoplasty combined with bilateral lateral mass screw fixation (ODL-BLMSF) is a relatively new surgical technique; however, its clinical effectiveness in managing MCSS-TCISCI has not been well-established. This study aims to assess the clinical value of ODL-BLMSF against MCSS-TCISCI.

Methods

We retrospectively analyzed 20 cases of MCSS-TCISCI treated with ODL-BLMSF from July 2016 to June 2020. Radiographic alterations of all included patients were measured using plain radiographs, CT scans, and MRI scans. Cervical lordosis was evaluated using C2-C7 Cobb angle and cervical curvature index (CCI) on lateral radiographs, and Pavlov ratio at the C5 level. Neurological functional recovery was assessed using Japanese Orthopaedic Association (JOA) scores and Nurick grade, while neck and axial symptoms were assessed using the neck disability index (NDI) and the visual analog scale (VAS). The paired t-test was utilized for statistical analysis.

Results

All included patients were followed up for an average period of 26.5 months (range: 24–30 months) after ODL-BLMSF. The average Pavlov ratio at the C5 level significantly improved from 0.57 ± 0.1 preoperatively to 1.13 ± 0.1 and 1.12 ± 0.04 at 6 months postoperatively and at the last follow-up (t = 16.347, 16.536, p < 0.001). Importantly, this approach significantly increased the JOA score from 5.0 ± 2.6 before surgery to 11.65 ± 4.3 and 12.1 ± 4.3 at 6 months postoperatively and at the last follow-up (t = 9.6, −9.600, p < 0.001), with an average JOA recovery rate of 59.1%; and the average Nurick disability score decreased from 3.0 ± 1.3 (preoperative) to 1.65 ± 1.22 and 1.5 ± 1.2 (6 months postoperatively and at last follow-up) (t = 5.111, 1.831, p < 0.001). Meanwhile, the NDI score decreased from 30.3 ± 4.3 preoperatively to 13.2 ± 9.2 at 6 months (t = 12.305, p < 0.001), and to 12.45 ± 8.6 at the final follow-up (t = 13.968, p < 0.001), while the VAS score decreased from 4.0 ± 1.5 preoperatively to 1.5 ± 0.7 at 6 months (t = 9.575, p < 0.001), and to 1.15 ± 0.7 at the final follow-up (t = 10.356, p < 0.001).

Conclusion

ODL-BLMSF can effectively dilate the stenotic spinal canal to decompress the spinal cord, maintain good cervical alignment and stability, and improve the recovery of neurological function and neck function. This technique is suitable for treating selected cases of MCSS-TCISCI.     

Dalteparin Vs Low-Dose Unfractionated Heparin for Prophylaxis Against Clinically Evident Venous Thromboembolism in Acute Traumatic Spinal Cord Injury: A Retrospective Cohort Study

Background: When venous thromboembolism (VTE) includes deep-vein thrombosis (DVT) and pulmonary embolism (PE), patients with acute traumatic spinal cord injury (SCI) have the highest incidence of VTE among all hospitalized groups, with PE the third most common cause of death. Although low-molecular-weight heparin (LMWH) outperforms low-dose unfractionated heparin (LDUH) in other patient populations, the evidence in SCI remains less robust.

Objective: To determine whether the efficacy for LMWH shown in previous SCI surveillance studies (eg, routine Doppler ultrasound) would translate into real-world effectiveness in which only clinically evident VTE is investigated (ie, after symptoms or signs present).

Methods: A retrospective cohort study was conducted of 90 patients receiving LMWH dalteparin (5,000 U daily) or LDUH (5,000 U twice daily) for VTE prophylaxis after acute traumatic SCI. The incidence of radiographically confirmed VTE was primarily analyzed, and secondary outcomes included complications of bleeding and heparin-induced thrombocytopenia.

Results: There was no statistically significant association (p = 0.7054) between the incidence of VTE (7.78% overall) and the type of prophylaxis received (LDUH 3/47 vs dalteparin 4/43). There was no significant differences in complications, location of VTE, and incidence of fatal PE. Paraplegia (as opposed to tetraplegia) was the only risk factor identified for VTE.

Conclusions: There continues to be an absence of definitive evidence for dalteparin (or other LMWH) over LDUH as the choice for VTE prophylaxis in patients with SCI. Novel approaches to VTE prophylaxis are urgently required for this population, whose risk of fatal PE has not decreased over the last 25 years.     

Provocative Stimulation of Growth Hormone: A Monozygotic Twin Study Discordant for Spinal Cord Injury

Abstract

Background/Objective: A blunted growth hormone (GH) response to provocative testing and/or low levels of plasma insulin-like growth factor-1 (IGF-I) have been reported in persons with spinal cord injury (SCI). A reduction in activity of the GH-IGF-I axis may have deleterious effects on body composition and function. Provocative testing for GH stimulation was performed to determine the response in monozygotic twins that were discordant for SCI.

Methods: GH stimulation testing was performed by the administration of intravenous arginine.

Results: Nine SCI twins with paraplegia, a mean age of 39 ± 9 years, and duration of injury of 14 ± 9 years were studied. The twins with SCI had a significantly lower body mass index than non-SCI twins (22.5 ± 4.0 vs 25.1 ± 4.2 kg/m²; P < 0.05); percent fat mass was greater in the twins with SCI (30 ± 11 % vs 22 ± 10%; P < 0.05). Baseline serum GH was correlated with percent fat only in the SCI twins. The response to GH provocative stimulation was less in the twins with SCI: peak GH response was 5.8 ± 6.6 vs 13.0 ± 7.3 ng/mL (P < 0.05), and sum GH response was 15.7 ± 15.6 vs 30.2 ± 17.3 ng/mL (P = 0.06). Although baseline serum GH was correlated with stimulated response in the SCI twins, this relationship was not found in the non-SCI twins. Adiposity was positively related to the provocative serum GH response in twins with SCI rather than negatively related, as noted in the non-SCI twins.

Conclusions: This study confirms and extends prior work that reported a reduction in stimulated GH release in persons with SCI, which was related to baseline values.     

Drug Susceptibility Testing Guided Treatment for Drug-Resistant Spinal Tuberculosis: A Retrospective Analysis of 19 Patients

Spinal tuberculosis is the most common manifestation of extrapulmonary tuberculosis. However, there have been few reports on the topic of drug-resistant spinal tuberculosis. The aim of this study was to investigate the efficacy and safety of treatment with a combination of surgery and individual chemotherapy guided by drug susceptibility testing for drug-resistant spinal tuberculosis. We retrospectively analyzed 19 patients with drug-resistant spinal tuberculosis. After surgery, individual chemotherapy was tailored for each patient according to his or her drug resistance profile and previous history of chemotherapy. The patients were followed up clinically and radiologically for an average period of 36 months. Among 19 drug-resistant spinal tuberculosis cases, 16 were multidrug-resistant tuberculosis (MDR-TB), and 3 were non–MDR-TB. The patients with MDR-TB and non–MDR-TB had undergone previous chemotherapy for an average of 12.50 ± 2.00 months (0–55 months) and 5.50 ± 1.20 months (0–60 months), respectively. A total of 16 patients underwent open operations, and the other 3 had percutaneous drainage and local chemotherapy. Patients received individual chemotherapy for an average of 24 months postoperatively. All patients had been cured at the final follow-up. Drug-resistant spinal tuberculosis is mainly acquired through previous irregular chemotherapy and the spread of drug-resistant strains. Treatment with a combination of surgery and individual chemotherapy is feasible in the treatment of severe complications and the prevention of acquired drug resistance.     

Provider Adherence to Implementation of Clinical Practice Guidelines for Neurogenic Bowel in Adults With Spinal Cord Injury

Abstract

Background/Objectives: Clinical Practice Guidelines (CPGs) have been published on a number of topics in spinal cord injury (SCI) medicine. Research in the general medical literature shows that the distribution of CPGs has a minimal effect on physician practice without targeted implementation strategies. The purpose of this study was to determine (a) whether dissemination of an SCI CPG improved the likelihood that patients would receive CPG recommended care and (b) whether adherence to CPG recommendations could be improved through a targeted implementation strategy. Specifically, this study addressed the " Neurogenic Bowel Management in Adults with Spinal Cord Injury" Clinical Practice Guideline published in March 1998 by the Consortium for Spinal Cord Medicine

Methods: CPG adherence was determined from medical record review at 6 Veterans Affairs SCI centers for 3 time periods: before guideline publication (T1 ), after guideline publication but before CPG implementation (T2), and after targeted CPG implementation (T3). Specific implementation strategies to enhance guideline adherence were chosen to address the barriers identified by SCI providers in focus groups before the intervention.

Results: Overall adherence to recommendations related to neurogenic bowel did not change between T1 and T2 (P = not significant) but increased significantly between T2 and T3 (P < 0.001) for 3 of 6 guideline recommendations. For the other 3 guideline recommendations, adherence rates were noted to be high at T1.

Conclusions: While publication of the CPG alone did not alter rates of provider adherence, the use of a targeted implementation plan resulted in increases in adherence rates with some (3 of 6) CPG recommendations for neurogenic bowel management.     

Clinical Significance of Abnormal Electrocardiographic Findings in Individuals Aging With Spinal Injury and Abnormal Lipid Profiles

Abstract

Background: Cardiovascular risk factors are common in individuals with chronic spinal cord injury (SCI), and their prevalence increases with age. The actual prevalence of overt cardiovascular disease (CVD) in this population has not been well established.

Methods: Electrocardiograms (ECGs) were examined for abnormalities in 43 individuals with abnormal lipid profiles being followed in the outpatient SCI clinic of our institution. The mean age of the study population of predominantly men was 43 ± 9.9 years and the mean duration of injury 16.6 ± 8 years.

Results: ECG abnormalities were common and present in 60.5% of participants. ST-T wave abnormalities were the most commonly observed (35%). Evidence of previous myocardial infarction was present in 7% of all individuals and in 12% of those with ECG abnormalities. The only clinical parameter differentiating the group with normal vs abnormal ECG was the duration of injury (19.5 ± 8 y vs 12 ± 5 y; P= 0.0026). Analysis of variance showed that injury duration was the sole predictor of abnormal ECG with 68% accuracy (P = 0.006). Among those with ECG abnormalities, although no significant differences were detected between those with and without evidence of previous myocardial infarction, mean total cholesterol and low-density lipoprotein were higher, and mean high-density lipoprotein was lower. Mean age and injury duration were greater in those with evidence of previous myocardial infarction.

Conclusion: Although age is an important risk factor for CVD in the population of individuals without disabilities, injury duration is at least as important as age in those with SCI. Our findings support the recommendation that individuals with SCI and abnormal lipids should be screened for CVD regardless of age.     

前路Ⅰ期病灶清除、植骨、内固定治疗脊柱结核(附37例报告)

观察前路Ⅰ期病灶清除、植骨、内固定治疗脊柱结核的疗效。方法 :1996年 1月～ 2 0 0 2年 12月间采用该手术方法共治疗脊柱结核 37例。其中 :颈椎 3例 ,胸椎 5例 ,胸腰椎 17例 ,腰椎 12例 ;3例伴窦道形成 ;9例伴不同程度的脊髓和 (或 )神经根受压的症状 ;术前后凸成角 10°～ 72° ,平均 31°。结果 :平均随访 1.7年 ,优良率为 90 %,植骨融合率可达 95 %,后凸矫正角度 13°,术后无一例复发。结论 :前路彻底病灶清除、植骨、内固定治疗脊柱结核病灶清除彻底 ,有利于恢复脊柱的稳定性 ,提高骨融合率 ,可纠正及预防脊柱后凸畸形。     

Clinical Assessment and Management of Obesity in Individuals With Spinal Cord Injury: A Review

Background: Diagnosing and managing obesity in individuals with spinal cord injury (SCI) remain challenging.

Methods: Literature on the epidemiology, impact, and management of obesity in individuals with SCI was reviewed.

Findings: Although nearly 66% of individuals with SCI are either overweight or obese, little guidance is available to measure and monitor obesity in the clinical setting. The use of anthropometric indices and specific cut points available for able-bodied persons is limited by the body composition changes that follow SCI. Indices of upper body obesity warrant examination in SCI because they provide an index of central obesity, which is more closely linked to some obesity-related conditions than is overall obesity. Investigations into the sequelae of excess body fat and its distribution are also needed in SCI because past research in this area has been inconclusive. Although limited, evidence regarding obesity interventions in SCI may be promising.

Conclusions: The best anthropometric tool to define obesity in the clinical setting remains unknown. SCI-specific assessment tools and a better understanding of the sequelae of excess body weight will lead to better targeting of prevention and treatment efforts. More research is needed on the individual components of a weight management program unique to SCI. Until then, providers are urged to use a team approach and draw on existing resources and applicable research in able-bodied individuals to facilitate weight management in individuals with SCI.     

Pulse Wave Velocity for Assessment of Arterial Stiffness Among People With Spinal Cord Injury: A Pilot Study

Background/Objective: The most significant complication and leading cause of death for people with spinal cord injury (SCI) is coronary artery disease (CAD). It has been confirmed that aortic pulse wave velocity (PVW) is an emerging CAD predictor among able-bodied individuals. No prior study has described PWV values among people with SCI. The objective of this study was to compare aortic (the common carotid to femoral artery) PWV, arm (the brachial to radial artery) PVW, and leg (the femoral to posterior tibial artery) PVW in people with SCI (SCI group) to able-bodied controls (non-SCI group).

Methods: Participants included 12 men with SCI and 9 non-SCI controls matched for age, sex, height, and weight. Participants with a history of CAD or current metabolic syndrome were excluded. Aortic, arm, and leg PVW was measured using the echo Doppler method.

Results: Aortic PVW (mean ± SD) in the SCI group (1,274 ± 369 cm/s) was significantly higher (P < 0.05) than in the non-SCI group (948 ± 110 cm/s). There were no significant between-group differences in mean arm PVW (SCI: 1,152 ± 193 cm/s, non-SCI: 1,237 ± 193 cm/s) or mean leg PVW (SCI: 1,096 ± 1 73 cm/s, non-SCI: 994 ±178 cm/s) values.

Conclusions: Aortic PVW was higher among the SCI group compared with the non-SCI group. The higher mean aortic PVW values among the SCI group compared with the non-SCI group indicated a higher risk of CAD among people with SCI in the absence of metabolic syndrome.     

Pulse Wave Velocity for Assessment of Arterial Stiffness Among People With Spinal Cord Injury: A Pilot Study

Background/Objective:     

胸腰椎三柱同时损伤内固定方法的实验与临床初步观察

利用传感器及电测技术,采用新鲜人体胸腰段脊柱标本,评价后路短节段内固定器Steffee钢板、前路Kaneda器械、前路Kaneda与后路CD棒联合应用及后路节段性椎板下钢丝固定哈氏撑开棒四种手术在植骨状态下,治疗脊柱完全性三柱损伤提供的生物力学稳定能力。Steffee、Kaneda器械及节段性椎板下钢丝固定的哈氏撑开棒手术在这种严重损伤类型各有力学弱点,Steffee后伸、Kaneda前屈、节段性椎板下钢丝固定的哈氏撑开棒旋转明显失稳,前后路联合手术在轴压、前屈、后伸、侧弯、旋转五种运动方式皆能提供良好的稳定性。以此方法治疗1例腰椎半椎体切除与1例腰椎肿瘤全切除,随访1年,脊柱稳定,植骨融合满意。作者建议,在脊柱三柱损伤时宜采用前后路联合固定手术。     

A Pilot Study of Factors Associated With Falls in Individuals With Incomplete Spinal Cord Injury

Abstract

Background/Objective: To determine factors associated with falls among a sample of ambulatory individuals with incomplete spinal cord injury (SCI).

Study Design: Cross-sectional mail survey.

Methods: A survey instrument of participant characteristics and fall-related variables was developed using relevant items from existing measures and was mailed to 221 individuals with incomplete SCI, who were identified from records of a large specialty hospital in the southeastern United States. Of the 221 prospective participants, 119 completed the questionnaire (54%). Multivariable logistic regression models were used to determine factors that were independently associated with having had a fall in the past year.

Results: After adjusting for covariates, having fallen in the past year was significantly (P < 0.05) associated with greater numbers of medical conditions (odds ratio [OR] = 1.3; 95% confidence interval [Cl] = 1.0-1.7), having arthritis (OR = 3.4, 95% Cl = 1.2-9.6), experiencing dizziness (OR = 5.6, 95% Cl = 1.1-27.7), greater numbers of days with poor physical health (OR = 1.1; 95% Cl = 1.0-1.3), and the restriction of community activities because of fear of falling (OR = 1.5, 95% Cl = 1.1-2.1). The multivariable models also showed that the odds of having fallen were significantly lower among those with better current perceived physical health (OR = 0.5; 95% Cl = 0.3-0.9), those with better perceived health compared to a year ago (OR = 0.4; 95% Cl = 0.2-0.8), individuals who exercised more frequently (OR = 0.2; 95% Cl = 0.1-0.7), and those who used a walker (OR = 0.3; 95% CI = 0.1-0.9).

Conclusions: Results suggest that interventions that address exercise frequency, walker use, and dizziness have promise for reducing falls for individuals with incomplete SCI.     

Safe cervical spine clearance in adult obtunded blunt trauma patients on the basis of a normal multidetector CT scan—A meta-analysis and cohort study

Background

A true gold standard to rule out a significant cervical spine injury in subset of blunt trauma patients with altered sensorium is still to be agreed upon. The objective of this study is to determine whether in obtunded adult patients with blunt trauma, a clinically significant injury to the cervical spine be ruled out on the basis of a normal multidetector cervical spine computed tomography.

Methods

Comprehensive database search was conducted to include all the prospective and retrospective studies on blunt trauma patients with altered sensorium undergoing cervical spine multidetector CT scan as core imaging modality to “clear” the cervical spine. The studies used two main gold standards, magnetic resonance imaging of the cervical spine and/or prolonged clinical follow-up. The data was extracted to report true positive, true negatives, false positives and false negatives. Meta-analysis of sensitivity, specificity, negative and positive predictive values was performed using Meta Analyst Beta 3.13 software.We also performed a retrospective investigation comparing a robust clinical follow-up and/or cervical spine MR findings in 53 obtunded blunt trauma patients, who previously had undergone a normal multidetector CT scan of the cervical spine reported by a radiologist.

Results

A total of 10 studies involving 1850 obtunded blunt trauma patients with initial cervical spine CT scan reported as normal were included in the final meta-analysis. The cumulative negative predictive value and specificity of cervical spine CT of the ten studies was 99.7% (99.4–99.9%, 95% confidence interval). The positive predictive value and sensitivity was 93.7% (84.0–97.7%, 95% confidence interval).In the retrospective review of our obtunded blunt trauma patients, none was later diagnosed to have significant cervical spine injury that required a change in clinical management.

Conclusion

In a blunt trauma patient with altered sensorium, a normal cervical spine CT scan is conclusive to safely rule out a clinically significant cervical spine injury. The results of this meta-analysis strongly support the removal of cervical precautions in obtunded blunt trauma patient after normal cervical spine computed tomography. Any further imaging like magnetic resonance imaging of the cervical spine should be performed on case-to-case basis.     

钛网椎管成形植骨脊柱融合的实验研究

目的 观察以犬作为实验动物,进行钛合金网为支撑物的脊柱椎管重建及植骨融合情况,并探讨其临床可行性。方法对6只蒙古犬进行静脉全麻,暴露T_(10)～L_3椎板,行全椎板减压,用钛丝将“Ω”形钛合金网固定并覆盖于减压区,上填自体骨及异种脱蛋白松质骨,逐层闭合伤口。于术后,6周、12周分别摄手术部位X线正侧位片及CT扫描,对比观察骨质愈合情况,钛网位置及椎管成形情况。同时宰杀3只动物,对实验部位行大体观察。结果 所有伤口均一期愈合。12周X线提示异种骨与钛网融合成片,形成椎板样结构,椎板与异种骨相接处骨质融合。CT扫描示椎管成形良好,硬膜囊未见骨性压迫。结论 应用钛网支撑植骨脊柱后路融合,可以在保护脊髓,神经根免于受压,维持减压效果的同时,有效的进行脊柱后路融合,在临床上有广阔的应用前景。