外伤性脊髓萎缩(1例报告及文献复习)

目的探讨外伤性脊髓萎缩的特征和治疗方法。方法系统观察１例外伤性脊髓萎缩的临床过程和影像改变，复习近年的有关文献。结果外伤性脊髓萎缩是一种少见的临床现象，ＭＲＩ上脊髓缩小部分从矢状径或横径测量为正常的１／４，即可诊断为脊髓萎缩。治疗上没有好的手段。结论ＭＲＩ能确诊外伤性脊髓萎缩，采用综合方法进行治疗。     

Evidence-Based Nursing Care for Spinal Nursing Immobilization: A Systematic Review

IntroductionA high degree of suspicion for spinal injury after trauma is commonplace in an emergency department, and spinal immobilization is considered an accepted intervention to prevent the progression of a potential injury. This systematic review was conducted to gain insight into the best research evidence related to nursing interventions for patients with trauma presenting with a suspected spinal injury.MethodsA systematic search of online databases was conducted in April 2019 for relevant research using specific search terms. The studies were selected on the basis of pre-established eligibility criteria, and the quality was appraised using the Critical Appraisal Skills Programme tool.ResultsNineteen included articles were synthesized thematically on the basis of the outcomes from interventions directed at a suspected spinal injury. The main findings were that spinal immobilization may compromise pulmonary function and airway management, cause pain and pressure ulcers, and be inappropriate with penetrating trauma. Furthermore, there was insufficient evidence to support the safety and efficacy of the hard neck collar and long backboard.DiscussionPatients would benefit from a more selective and cautious approach to spinal immobilization. Emergency nurses should use the evidence to facilitate informed decision-making in balancing the benefits of spinal immobilization against harm when considering the needs and values of the patient.     

乳酸清除率评估重症创伤患者预后的临床研究

目的 评估乳酸清除率与重症创伤患者预后的关系.方法 回顾性分析2010年1-6月收住曲靖市第一人民医院ICU科的37例重症创伤患者的初始血乳酸值、第2次血乳酸值、乳酸清除率及患者的预后,将患者分为存活组和死亡组,比较两组患者初始血乳酸值、乳酸清除率的差异.结果 两组患者年龄、性别、初始血乳酸值差异无统计学意义(P﹥0....     

Real-Time Monitoring of Stresses and Displacements in Cervical Nuclei Pulposi During Cervical Spine Manipulation: A Finite Element Model Analysis

Objective

The objective of this study was to research the distribution of stresses and displacements in cervical nuclei pulposi during simulated cervical spine manipulation (CSM).

Methods

A 3-dimensional finite element model of C_3/4~ C_6/7 was established. The detailed mechanical parameters of CSM were analyzed and simulated. During the process, the changes in stresses and displacements of cervical nuclei pulposi within the model were displayed simultaneously and dynamically.

Results

Cervical spine manipulation with right rotation was targeted at the C₄ spinous process of the model. During traction, levels of stresses and displacements of the nuclei pulposi exhibited an initial decrease followed by an increase. The major stresses and displacements affected the C_3/4 nucleus pulposus during rotation in CSM, when its morphology gradually changed from circular to elliptical. The highest stress (48.53 kPa) occurred at its right superior edge, on rotating 40° to the right. It protruded toward the right superior, creating a gap in its left inferior aspect. The highest displacement, also at 40° right, occurred at its left superior edge and measured 0.7966 mm. Dimensions of stresses and displacements reduced quickly on rapid return to neutral position.

Conclusion

The morphology of the C_3/4 nucleus pulposus changed during CSM with right rotation, and it created a gap in its left inferior aspect. Biomechanically, it is more safe and rational to rotate toward the healthy side than the prolapsed side of the intervertebral disk during CSM. Upon ensuring due safety, the closer the application force is to the diseased intervertebral disk, the better is the effect of CSM.     

Cervical Manipulation and Vertebral Artery Injury: A Literature Review

Abstract

Understanding the risks and benefits of manipulation of the cervical spine is essential in developing effective and safe intervention strategies for patients with cervical spine pain. A review of the literature was performed to assess the effectiveness, benefits, and risks as well as the prudence of performing manipulation to the cervical spine as it relates to vertebral artery injury.     

紫草油用于宫颈止血70例临床观察

采用自制的紫草油棉球治疗宫颈出血７０例，显效５８例（８２．９％），有效１２例（１７．１％），用药后病人无局部不适，也未出现局部感染及继发性出血。     

颈椎损伤的早期非手术性干预

目的：探讨颈椎损伤的急救处理中早期非手术干预的意义。方法：回顾分析1996年1月-2004年12月疗治的194例颈椎损伤患者的急救支持与10类715例次并发症发生、治疗及预防措施。结果：规范与程序化急救可明显降低早期死亡率；肺部并发症是死亡的主要原因。结论：颈椎损伤的早期并发症的发生时间往往比较集中，也较有规律，如果能够预防和正确处理则可为治疗、神经功能恢复和康复创造有利条件。     

颈椎后纵韧带骨化症的CT表现

目的探讨颈椎后纵韧带骨化症（OPLL）的CT表现及其诊断价值。方法回顾性分析2004年11月2009年10月收治的6480例颈椎患者的CT图像资料,观察后纵韧带骨化块的形态、位置及与椎管的关系,计算椎管狭窄率。结果 6480例颈椎CT图像中,37例发现OPLL,占0.57%（37/6480）。颈椎后纵韧带骨化块表现为点状、条状、线状、平板状、山丘状、蕈伞状及花边状,呈现局限型、节段型、连续型、混合型特点。C4、C5及C6为颈椎后纵韧带骨化常见位置。骨化块平均厚度为4.12mm,骨化块致椎管矢状径狭窄率为10.20%～49.18%,多位于椎管前方中间位置。椎管狭窄率〉34.10%,临床症状明显。结论 CT检查能较好地显示颈椎后纵韧带骨化块的特征及椎管的狭窄程度,是临床医生选择手术方案和术后评估预后的一种较好方法。     

上颈椎损伤的早期诊断与治疗

目的：探讨上颈椎损伤的早期诊断方法和治疗措施。方法：回顾分析2000年1月至2008年7月间收治住院的上颈椎损伤患者35例临床资料,其中寰椎骨折6例,枢椎骨折24例,无骨折的寰枢关节脱位5例。除3例陈旧性齿状突骨折和2例陈旧性寰枢关节脱位外,其余为新鲜损伤。评价其早期诊治方法及其预后。结果：早期漏诊6例,35例患者X线检查后均需结合CT或MRI检查完善诊断及分型。手术治疗18例,其中5例为齿状突骨折早期保守治疗后改手术治疗,2例为漏诊的陈旧性寰枢关节脱位。非手术治愈16例,其中3例齿状突骨折Ⅲ型畸形愈合。1例复合性损伤患者住院3月后诊断出寰枢关节脱位出院。33例得到4～38个月随访。随访的33例患者中,骨折患者均愈合,4例寰枢关节脱位患者脱位整复,上颈椎稳定性均维持良好,神经功能改善。结论：重视上颈椎损伤患者影像检查方法早期合理的分步选择与充分利用,避免漏诊。治疗上,积极地整复骨折与脱位,尽早恢复上颈椎的稳定性。     

无骨折脱位型颈脊髓损伤合并颈椎病治疗及影响因素

目的　分析无骨折脱位型颈脊髓损伤合并颈椎病的疗效和影响因素。方法　对 30例患者进行回顾性研究。结果　 1合并脊髓型者脊髓功能恢复停滞早于神经根者 ,而且差。但是后期二者脊髓功能均出现恶化。 2手术效果明显优于保守疗法。 3无论合并何型颈椎病 ,远期疗效与手术时机均呈负相关 (P<0 .0 5 )。 4远期疗效与合并脊髓型的病程呈负相关 (P<0 .0 5 )。结论　早期手术是此类损伤首选疗法。合并脊髓型者更应尽早手术。     

A Prospective Study of Complications of Cervical Spine Manipulation

Abstract

Complications or adverse responses to cervical spine manipulation, particularly neurovascular compromise, are well documented in the literature. However, the rate of incidence of such adverse responses in manipulative physiotherapy has not been documented, indicating a need for well-designed prospective studies to accurately determine the associated risk of these procedures. To this end, a pilot study trialling a prospective adverse response reporting system was undertaken over a three month period in New Zealand. Twenty manipulative physiotherapists were approached to participate by reporting and describing any adverse responses to cervical spine manipulation they experienced over this time. Nine manipulative physiotherapists were able to participate and reported only one minor incident, a temporary, mild exacerbation of neck pain. It was calculated that the incidence rate for this study was 0.21% per manipulation and 0.42% per patient. The sole notable problem encountered with the methodology was the moderate response rate.     

预见性护理程序在中重度创伤病人护理中的应用

目的 :为使创伤病人在急诊科赢得抢救“黄金时间” ,提高抢救成功率。方法 :应用自行设计的创伤病人预见性护理程序 ,于 1996年 3月至 1998年 3月 ,对中重度创伤病人休克的早期预防和护理进行研究 ,观察组按预见性护理程序护理 ,对照组按急诊科常规护理程序护理 ,比较两组有效抢救时间。结果 :观察组比对照组提前 2 8min。结论 :预见性护理程序为病人赢得了时间 ,提高了病人生存质量     

Best Practice in Diagnostic Imaging after Blunt Force Trauma Injury to the Cervical Spine: A Systematic Review

IntroductionThe aim of this study was to investigate best practice in evidence-based clinical examinations to determine the diagnostic efficacy of plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI) of a cervical spine injury after blunt force trauma.MethodsA systematic review of recent literature was performed, with the intention of analysing only original research articles focusing on at least two imaging modalities or clinical decision guidelines in relation to blunt force trauma injuries involving the cervical spine. The search used the following databases: ProQuest Central, ScienceDirect, and Scopus. A total of 18 studies were identified as suitable for review; these were further supported by relevant secondary studies.ResultsIt was found that the National Emergency X-Radiology Utilization Study and the Canadian C-Spine Rule are both highly sensitive methods for screening patients after cervical spine injuries. CT was shown to have a higher validity than plain radiography and MRI for the detection of a bony cervical spine injury. MRI is recommended for obtunded or unevaluable patients with suspected neurologic deficit.ConclusionsOverall, the literature appears to suggest that individuals with a suspected high risk of injury after examination using clinical decision rules should undergo a cervical CT examination. For patients who are found to have a low risk of injury after clinical decision guidelines, good-quality plain radiography is recommended as sufficient.     

Coupling Behavior of the Lumbar Spine: A Literature Review

Abstract

Coupling behavior has been described as fundamental to the theory of lumbar biomechanics. Different manual therapy approaches use discrepant coupling biomechanical models. Despite these inconsistencies, coupling models have been frequently used in the management of low back pain. The purpose of this paper is to investigate evidence for the use of coupling biomechanical modeling in manual therapy assessment and treatment. The findings of this paper suggest that use of a single dogmatic lumbar spinal coupling approach utilizing a side-bend initiation may not be appropriate and could lead to unreliable findings. The use of rotation initiation needs further consideration. Coupling behavior may be more consistent if rotation is initiated first, however there is insufficient evidence to substantiate this view.     

颈椎损伤的X线与CT诊断

目的探讨常规X线和CT扫描对颈椎损伤的诊断价值。方法对50例X线和CT诊断为颈椎损伤的病例进行分析。结果本组50例,受损椎体共60个。低位颈椎骨折并（或）脱位27例,寰椎骨折9例,寰枢椎脱位8例,枢椎骨折6例。X线平片显示椎体后缘联线异常24例,CT片根据脊柱三柱结构诊断不稳定骨折28例,椎管0度狭窄22例,1度狭窄17例,2度狭窄8例,3度狭窄3例。外伤性颈椎间盘脱出10例。结论对于颈椎损伤的患者,应常规行X线和CT扫描检查,以利于为临床提供更全面可靠的信息。CT能对颈椎损伤做出较全面、准确的诊断,有利于治疗方案的选择,可作为颈椎损伤临床术前诊断和治疗的影像学检查的首选方法。