{"title":"高山救援规程中要移除颈套吗?在真实的山地条件下进行的生物力学非劣效性试验。","authors":"Guillaume Grenier, Marc-Antoine Despatis, Karina Lebel, Mathieu Hamel, Camille Martin, Patrick Boissy","doi":"10.1186/s13049-022-01031-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Alpine skiing rescues are challenging because of the mountainous environment and risks of cervical spine motion (CSM) induced during victims' extrications (EXs) and downhill evacuations (DEs). The benefits of applying a cervical collar (CC) over manual in-line stabilization without CC (MILS) in terms of spinal motion restriction during simulated alpine rescues are undocumented. Our hypothesis was that CSM recorded using MILS alone is non-inferior to CSM recorded with a CC according to a 10 degrees margin.</p><p><strong>Methods: </strong>A total of 32 alpine extrications and 4 downhill evacuations on different slope conditions were performed using a high fidelity mannequin designed with a motion sensors instrumented cervical spine. The primary outcome was the peak extrication 3D excursion angle (Peak 3D θ<sub>EX,</sub>) of the mannequin's head. The secondary objectives were to describe the time to extrication completion (tEX) and to highlight which extrication manipulation is more likely to induce CSM.</p><p><strong>Results: </strong>The median Peak 3D θ<sub>EX</sub> recorded during flat terrain extrications using CC was 10.77° (95% CI 7.31°-16.45°) compared to 13.06° (95% CI 10.20°-30.36°) using MILS, and 16.09° (95% CI 9.07°-37.43°) for CC versus 16.65° (95% CI 13.80°-23.40°) using MILS on a steep slope. Peak 3D θ<sub>EX</sub> with CC or using MILS during extrications were equivalent according to a 10 degrees non-inferiority hypothesis testing (p < 0.05). Time to extrication completion (tEX) was significantly reduced using MILS without CC on a flat terrain with a median duration of 237,3 s (95% CI 197.8 s, 272.2 s) compared to 358.7 s (95% CI 324.1 s, 472.4 s). During downhill evacuations, CSM with and without CC across all terrain conditions were negligible (< 5°). When CC is used; its installation manipulation induces the highest CSM. When EXs are done using MILS without CC, the logroll initiation is the manipulation inducing the highest risk of CSM.</p><p><strong>Conclusion: </strong>For experienced ski patrollers, the biomechanical benefits of spinal motion restriction provided by CC over MILS during alpine skiing rescues appear to be marginal and CC use negatively affects rescue time.</p>","PeriodicalId":501057,"journal":{"name":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","volume":" ","pages":"42"},"PeriodicalIF":0.0000,"publicationDate":"2022-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235139/pdf/","citationCount":"0","resultStr":"{\"title\":\"Removal of the cervical collar from alpine rescue protocols? 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Our hypothesis was that CSM recorded using MILS alone is non-inferior to CSM recorded with a CC according to a 10 degrees margin.</p><p><strong>Methods: </strong>A total of 32 alpine extrications and 4 downhill evacuations on different slope conditions were performed using a high fidelity mannequin designed with a motion sensors instrumented cervical spine. The primary outcome was the peak extrication 3D excursion angle (Peak 3D θ<sub>EX,</sub>) of the mannequin's head. The secondary objectives were to describe the time to extrication completion (tEX) and to highlight which extrication manipulation is more likely to induce CSM.</p><p><strong>Results: </strong>The median Peak 3D θ<sub>EX</sub> recorded during flat terrain extrications using CC was 10.77° (95% CI 7.31°-16.45°) compared to 13.06° (95% CI 10.20°-30.36°) using MILS, and 16.09° (95% CI 9.07°-37.43°) for CC versus 16.65° (95% CI 13.80°-23.40°) using MILS on a steep slope. Peak 3D θ<sub>EX</sub> with CC or using MILS during extrications were equivalent according to a 10 degrees non-inferiority hypothesis testing (p < 0.05). Time to extrication completion (tEX) was significantly reduced using MILS without CC on a flat terrain with a median duration of 237,3 s (95% CI 197.8 s, 272.2 s) compared to 358.7 s (95% CI 324.1 s, 472.4 s). During downhill evacuations, CSM with and without CC across all terrain conditions were negligible (< 5°). When CC is used; its installation manipulation induces the highest CSM. When EXs are done using MILS without CC, the logroll initiation is the manipulation inducing the highest risk of CSM.</p><p><strong>Conclusion: </strong>For experienced ski patrollers, the biomechanical benefits of spinal motion restriction provided by CC over MILS during alpine skiing rescues appear to be marginal and CC use negatively affects rescue time.</p>\",\"PeriodicalId\":501057,\"journal\":{\"name\":\"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine\",\"volume\":\" \",\"pages\":\"42\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-06-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235139/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13049-022-01031-3\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13049-022-01031-3","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景:高山滑雪救援是具有挑战性的，因为山区环境和风险的颈椎运动(CSM)引起的受害者的解脱(EXs)和下坡疏散(DEs)。在模拟高山救援期间，在脊柱运动限制方面，应用颈项圈(CC)比没有CC (MILS)的手动在线稳定的好处没有文献记载。我们的假设是，单独使用MILS记录的CSM不劣于使用CC记录的CSM，根据10度的裕度。方法:采用基于运动传感器的颈椎高保真假人模型，在不同坡度条件下进行32例高山取出术和4例下坡取出术。主要结果是人体模型头部的峰值解脱3D偏移角(峰值3D θEX，)。次要目的是描述脱位完成的时间(tEX)，并强调哪种脱位操作更有可能诱发CSM。结果:在平坦地形提取过程中，使用CC记录的中位数峰值3D θEX为10.77°(95% CI 7.31°-16.45°)，而使用MILS的中位数峰值为13.06°(95% CI 10.20°-30.36°)，在陡坡上使用MILS的中位数峰值为16.09°(95% CI 9.07°-37.43°)，而使用CC的中位数峰值为16.65°(95% CI 13.80°-23.40°)。根据10度非自效性假设检验，在提取过程中，使用CC或使用MILS的峰值3D θEX是相当的(p)。结论:对于经验丰富的滑雪巡逻员来说，在高山滑雪救援过程中，CC提供的脊柱运动限制比MILS提供的生物力学好处似乎是边际的，使用CC对救援时间有负面影响。
Removal of the cervical collar from alpine rescue protocols? A biomechanical non-inferiority trial in real-life mountain conditions.
Background: Alpine skiing rescues are challenging because of the mountainous environment and risks of cervical spine motion (CSM) induced during victims' extrications (EXs) and downhill evacuations (DEs). The benefits of applying a cervical collar (CC) over manual in-line stabilization without CC (MILS) in terms of spinal motion restriction during simulated alpine rescues are undocumented. Our hypothesis was that CSM recorded using MILS alone is non-inferior to CSM recorded with a CC according to a 10 degrees margin.
Methods: A total of 32 alpine extrications and 4 downhill evacuations on different slope conditions were performed using a high fidelity mannequin designed with a motion sensors instrumented cervical spine. The primary outcome was the peak extrication 3D excursion angle (Peak 3D θEX,) of the mannequin's head. The secondary objectives were to describe the time to extrication completion (tEX) and to highlight which extrication manipulation is more likely to induce CSM.
Results: The median Peak 3D θEX recorded during flat terrain extrications using CC was 10.77° (95% CI 7.31°-16.45°) compared to 13.06° (95% CI 10.20°-30.36°) using MILS, and 16.09° (95% CI 9.07°-37.43°) for CC versus 16.65° (95% CI 13.80°-23.40°) using MILS on a steep slope. Peak 3D θEX with CC or using MILS during extrications were equivalent according to a 10 degrees non-inferiority hypothesis testing (p < 0.05). Time to extrication completion (tEX) was significantly reduced using MILS without CC on a flat terrain with a median duration of 237,3 s (95% CI 197.8 s, 272.2 s) compared to 358.7 s (95% CI 324.1 s, 472.4 s). During downhill evacuations, CSM with and without CC across all terrain conditions were negligible (< 5°). When CC is used; its installation manipulation induces the highest CSM. When EXs are done using MILS without CC, the logroll initiation is the manipulation inducing the highest risk of CSM.
Conclusion: For experienced ski patrollers, the biomechanical benefits of spinal motion restriction provided by CC over MILS during alpine skiing rescues appear to be marginal and CC use negatively affects rescue time.
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