背景:颈椎骨折后颈椎固定的当前方案在老年人的急性康复中被广泛接受,然而,对其总体有效性仍缺乏共识。
目的:总结有关颈椎骨折后可用颈椎固定方案的原始研究的信息并回答问题;哪些类型的研究设计已用于评估这些方案的有效性?目前报道的成人颈椎骨折后颈椎固定方案是什么?这些方案的有效性是什么?2月与这些方案相关的不良事件是什么?MEDLINE,CINAHL,中央。在数据库中搜索与颈椎骨折后使用项圈有关的文章。
方法:颈椎骨折固定方案的有效性是主要结果,通过各种措施进行检查,包括工会率和残疾指数。
方法:搜索了4个数据库;EMBASE,MEDLINE,护理和相关健康文献累积指数(CINAHL),和Cochrane中央对照试验注册中心(CENTRAL)于2023年2月23日开始,其中5,127项研究进行了研究,32项基于对成人(≥18岁)的研究进行了提取,诊断为颈椎骨折(C0-C7)通过刚性外部矫形器进行管理,以防止不稳定和手术(项圈,或颈胸矫形器)。使用JoannaBriggs研究所制定的指南评估偏倚风险。
结果:这项范围审查产生了低水平的前瞻性(18%)和回顾性(69%)队列研究,病例对照研究(3%),和病例系列(6%)从1987年到2022年,患者年龄从14岁到104岁。由于缺乏随机对照试验,研究结果难以总结,导致没有关于标准化宫颈固定方案的明确结论,也没有关于治疗持续时间或护理过渡的信息。大多数纳入的文章是质量低到中等的回顾性队列研究,对干预问题有很大的偏见风险。这些方案的有效性尚不清楚,因为大多数研究评估了异质性结局,并且没有表现出组间差异。死亡率,肌肉骨骼(MSK)并发症,延迟手术是与使用颈领相关的常见不良事件.
结论:这项范围审查强调了需要更高水平的证据,因为目前没有用于颈椎骨折的标准化固定方案作为主要治疗方法,宫颈固定方案的有效性尚不清楚,和死亡率,MSK并发症,延迟手术是常见的不良事件。本次范围审查没有使用任何资金来源。
BACKGROUND: Current protocols on cervical immobilization postcervical spine fracture are widely accepted in the acute rehabilitation of older adults, however consensus on its overall effectiveness remains lacking.
OBJECTIVE: Summarize information from original studies on available cervical immobilization protocols following a cervical fracture and to answer the questions; Which types of study designs have been used to assess the effectiveness of these protocols? What are the currently reported cervical immobilization protocols following cervical fracture in adults? What is the effectiveness of these protocols? What adverse events are associated with these protocols?
METHODS: Scoping
review was performed.
METHODS: Searches were performed on the following online databases from inception to February 23, 2023: EMBASE, MEDLINE, CINAHL, and CENTRAL. Databases were searched for articles pertaining to collar use post cervical spine fracture.
METHODS: Effectiveness of the cervical fracture immobilization protocols was the primary outcome, examined by various measures including union rates and disability indexes.
METHODS: 4 databases were searched; EMBASE, MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials (CENTRAL) beginning on February 23, 2023, where 5,127 studies were yielded and 32 were extracted based on studies of adults (≥18 years) with a diagnosis of a cervical fracture (C0-C7) managed with a rigid external
orthosis to prevent instability and surgery (collar, or cervicothoracic
orthosis). Risk of bias was assessed using the guidelines set out by the Joanna Briggs Institute.
RESULTS: This scoping review yielded low-level prospective (18%) and retrospective (69%) cohort studies, case-control studies (3%), and case series (6%) from 1987 to 2022, patient age ranged from 14 to 104 years. Findings were difficult to summarize based on the lack of randomized controlled trials, leading to no clear conclusions drawn on the presence of standardized cervical immobilization protocols with no information on the duration of treatment or transition in care. Most included articles were retrospective cohort studies of poor to moderate quality, which have significant risk of bias for intervention questions. The effectiveness of these protocols remains unclear as most studies evaluated heterogeneous outcomes and did not present between-group differences. Mortality, musculoskeletal (MSK) complications, and delayed surgery were common adverse events associated with cervical collar use.
CONCLUSIONS: This scoping
review highlights the need for higher levels of evidence as there is currently no standardized immobilization protocol for cervical spine fractures as a primary treatment, the effectiveness of cervical immobilization protocols is unclear, and mortality, MSK complications, and delayed surgery are common adverse events. No sources of funding were used for this scoping
review.