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Wirbelsäulenverletzung in der Präklinik

Systematischer Überblick

Preclinical management of vertebral injuries

A systematic review

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Zusammenfassung

In der präklinischen Versorgung von Patienten mit Verdacht auf eine Verletzung der Wirbelsäule liegt der Schwerpunkt darin, keine neurologischen Schäden neu zu setzen oder bestehende zu verschlimmern. In der Erstversorgung muss entsprechend der Unfallsituation an die Möglichkeit einer Wirbelsäulenverletzung gedacht werden. Nur wenn weder Bewusstseinsstörung noch neurologisches Defizit noch Wirbelsäulenschmerzen oder Muskelhartspann noch Intoxikation noch Extremitätentrauma vorliegen, kann mit hoher Sicherheit eine Wirbelsäulenverletzung ausgeschlossen werden. Auffällige Patienten sollten mit einer Zervikalstütze immobilisiert und mittels Schaufeltrage, Spineboard oder Immobilisationskorsett vom Schadensort gerettet werden. Danach sollte die vollständige Immobilisierung auf einer Vakuummatratze mit Verletztentragetuch erfolgen. Während die präklinische Analgesie gut akzeptiert ist, wird der Wert einer Kortisontherapie aufgrund neuerer Studien kritisch beurteilt. Da die frühe operative Versorgung vorteilhaft sein kann, sollte der primäre Transport des Patienten in ein Zentrum mit Wirbelsäulenchirurgie angestrebt werden. Dieser sollte sowohl schonend als auch zügig durchgeführt werden.

Abstract

The focus of preclinical management of trauma patients with suspicious vertebral injury is the avoidance of both additional neurological lesions and worsening of the present lesions. Dependent on the trauma mechanisms involved, primary care at the scene has to consider and assess vertebral injury. Associated vertebral injuries may be excluded only in the absence of disturbed consciousness, neurological deficits, vertebral pain, muscular rigidity, intoxication and extremity trauma. Otherwise, patients with potential vertebral injury should be immobilized at the scene with a cervical collar and afterwards rescued using either a padded board, spine-board or immobilization corset. For transportation, complete immobilization should be assured on a rescue cloth using a vacuum-sealed backboard. Whereas preclinical analgesia is well accepted and standardized, the accompanying corticoid therapy is controversial. Since early surgical intervention may be beneficial, the primary destination should be the nearest trauma centre providing vertebral surgical care. Therefore, a gentle and speedy transport is indicated.

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Authors and Affiliations

  1. Abteilung für Unfallchirurgie, Hand-, Plastische und Wiederherstellungschirurgie, Universität, Ulm

    A. Beck & M. Huber-Lang

  2. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum, Rosenheim

    M. Bayeff-Filloff

  3. Biochemische und Experimentelle Abteilung, Medizinische Fakultät, Universität, Köln

    S. Sauerland

  4. Abteilung für Unfallchirurgie, Hand-, Plastische und Wiederherstellungschirurgie, Universität Ulm, Steinhövelstraße 9, 89075, Ulm

    A. Beck

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  1. A. Beck
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AG „Notfallmedizin“ der Deutschen Gesellschaft für Unfallchirurgie

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Correspondence to A. Beck.

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Mitglieder der AG „Notfallmedizin“ der Deutschen Gesellschaft für Unfallchirurgie:

Dr. Hermann-Josef Bail, Mannheim

Dr. Mark Bardenheuer, Mannheim

Dr. Michael Bayeff-Filloff, Rosenheim

PD Dr. Alexander Beck, Ulm

Dr. Achim Biewener, Dresden

Prof. Dr. Bertil Bouillon, Köln

Dr. Marc Fischbacher, Essen

Dr. Sebastian Hentsch, Berlin

Dr. Ewald Hüls, Celle

Dr. Karl-Georg Kanz, München

Prof. Dr. Christian K. Lackner, München

Dr. Lutz Mahlke, Hannover

Dr. Ivan Marintschev, Halle

Dr. Gerrit Matthes, Berlin

Dr. Hubert Mayer, Augsburg

Dr. M. Raum, Köln

Dr. Stefan Sauerland, Köln

Dr. Ulrich Schächinger, Regensburg

Dr. Thomas Schildhauer, Bochum

Prof. Dr. Andreas Seekamp, Homburg

Dr. Erwin Stolpe, München

Prof. Dr. Johannes Sturm, Detmold

Dr. F. Walcher, Frankfurt

Prof. Dr. Christian Waydhas, Essen

Dr. Michael Weinlich, Filderstadt

Dr. Christoph Wölfl, Ludwigshafen

Dr. Gerald Zimmermann, Ludwigshafen

Gefördert durch die Deutsche Forschungsgemeinschaft (Projekt-Nr. NE 385/5–3)

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Beck, A., Bayeff-Filloff, M., Sauerland, S. et al. Wirbelsäulenverletzung in der Präklinik. Notfall & Rettungsmedizin 8, 162–170 (2005). https://doi.org/10.1007/s10049-005-0726-6

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