頸椎固定をされずに搬送されてきた頸椎・頸髄損傷例の検討

Clinical Analysis of Cervical Spine and Spinal Cord Injured Patients Who Were Brought without Cervical Spinal Immobilization

　Ⅰ．はじめに

　外傷患者における脊椎の固定はプレホスピタルケアおよび初期治療における基本的かつ重要な処置の1つである．しかし，現状では，救急医療の中で，その意義や必要性が十分理解・徹底され，適切に実行されているとは言い難い状況である．実際に頸椎・頸髄損傷の治療に携わる脳神経外科医や整形外科医も同様である．救急隊が全身固定を行い搬送してきたにもかかわらず，不確実な頸椎保護のまま，診療を行い，神経症状を増悪させる場合がみられる．

　今回，われわれは，当院に搬送された頸椎・頸髄損傷患者のうち来院時に頸椎固定（頸椎カラー装着等）をされていなかった症例について検討し，その問題点を明らかにした．

　The purpose of this study was to determine the incidence of mismanaged injury of the cervical spinal cord,to identify factors contributing to a failure to recognize such injury.

　Thirty-three patients with cervical spinal cord injury were transported to emergency department during the period from October,1999 to March,2001. Seven patients (21%) of them were transferred without cervical spine immobilization. Mechanism of injury in 7 patients was fall in 4,motor vehicle crash in 2,unknown in one. Clinical signs on admission revealed neck pain and/or back pain in 4 patients,altered mental status in 4 patients,numbness of extremities in 2 patients,paradoxical respiration in 2 patients,respiratory arrest in one. Neurological classification of Frankel grade was A in 2,B in 1,C in 2,D in 1 and E in 1. All trauma patients with a cervical spine injury or with a mechanism of injury having the potential to cause cervical spine injury should be immobilized at the scene,during transport and at the emergency room by using one of several available methods.