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(Clinical Practice Guidelines for Cervical Spine Injury)

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©∫—∫∑’Ë 1 æ.». 2548 (æ‘¡æå§√—Èß∑’Ë 1)
ISBN : 974-422-173-9

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Õ.®‘√æ√ πæ.µ.∏’√™—¬ πæ. 6.√.¡—¬∏—™ πæ. 12. 20.Õ—¡æ√ æ≈.πæ. 9.». 18. 26.πæ.‡Õ° æ. 14. .ª√–‡ √‘∞ π.æ‘™‘µ πæ.§≥–∑”ß“π‚§√ß°“√®—¥∑” ·π«∑“ß°“√√—°…“°“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ  ∂“∫—πª√– “∑«‘∑¬“ °√¡°“√·æ∑¬å 1. ¡“π πæ.Õ. 15.«’√–«—≤πå πæ.∏«—™ º. 7.«’√– πæ. 4.»ÿ¿‚™§ πæ.πæ.Õ.πæ.Õπÿ»—°¥‘Ï πæ. 22. 27.ª√–°‘µ √.æ≠.».™àՇ撬« √.πæ.∑.». 10.πæ. 13. 11. 3.ª√–≥µ πæ.¿“ °√ æ.πæ. 23.§”æ√ πæ.πæ.∑.«√—∑ æ. 5. 24.摇™…∞ πæ.». 17. 21. 8. «‘ß æ. ÿ√π‘ ∑√å º.ª√– “∑ πæ.».°àÕ°Ÿâ √.πæ.æ’√æß…å πæ. 25.». 2. πæ. ‘√√ÿ®πå æ.°ÿ≈æ—≤πå πæ.Õ. 26. 16. 19.πæ.Õ‘ √’ ‚Àµ√¿«“ππ∑å  “¡‡ π Õπÿ«ÿ≤‘π“«‘π ®ß‡ √’®‘µµå ™“≠«‘‡»… µ—ÈßÕ√ÿ≥»‘≈ªá ªíπ®—¬ ’Àå ®‘µ√«“≥‘™ ª√– “∑ƒ∑∏“ ‡™’¬ß∑Õß ‡∑’¬π∫ÿ≠ ‡À≈à“∏√√¡∑—»πå ‡µ‚™Ã“√ ∏πæ‘æ≤— π»‘√‘ À—ß  Ÿµ  °ÿ≈≥–¡√√§“ ∑√√»π–«‘¿“  «‘√“«√√≥ π‘æ—∑∏å —°¢å  ÿ¢ ßà“‡®√‘≠  ∂‘√Õ—ß°Ÿ√ ¡πµ√’«‘«—≤π™—¬ ‡¡∏“√—°…å™’æ º“≥‘µæß»å ‡≈’¬ßÕÿ¥¡ «’√ “√ ‡Õ’ˬ¡ª√’™“°ÿ≈ µ√’°¡≈ ∑’˪√÷°…“ ∑’˪√÷°…“ ∑’˪√÷°…“ ∑’˪√÷°…“ ∑’˪√÷°…“ ª√–∏“π √Õߪ√–∏“π §≥–∑”ß“π §≥–∑”ß“π §≥–∑”ß“π §≥–∑”ß“π §≥–∑”ß“π §≥–∑”ß“π §≥–∑”ß“π §≥–∑”ß“π §≥–∑”ß“π §≥–∑”ß“π §≥–∑”ß“π §≥–∑”ß“π §≥–∑”ß“π §≥–∑”ß“π §≥–∑”ß“π §≥–∑”ß“π §≥–∑”ß“π §≥–∑”ß“π ‡≈¢“πÿ°“√ ºŸâ™à«¬‡≈¢“πÿ°“√ 1 ºŸâ™à«¬‡≈¢“πÿ°“√ 2 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ (iii) 7 .

8 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ .

7 .3 ¢ÕßÕÿ∫—µ‘‡Àµÿ∑—ÈßÀ¡¥1-4 ºŸâ∑‰’Ë ¥â√—∫∫“¥‡®Á∫¢Õß °√–¥Ÿ° —πÀ≈—ß à«π§Õ®”π«πÀπ÷ßË ‡ ’¬™’«µ‘ À√◊Õæ‘°“√µ≈Õ¥™’«µ‘ ∑”„À⇪ìπ¿“√–¢Õߧ√Õ∫§√—« ‡°‘¥§«“¡ Ÿ≠‡ ’¬ ¥â“π —ߧ¡·≈–‡»√…∞°‘®¢Õߪ√–‡∑»Õ¬à“ß¡“° ·¡â«à“°“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ‡ªìπ‡√◊ËÕß∑’Ëæ∫∫àÕ¬·≈– ”§—≠ ·µà¬—߇ªìπªí≠À“∑’ˬ—߉¡à¡’ ·π«∑“ß„π°“√®—¥°“√∑’ˇÀ¡“– ¡ ∫ÿ§≈“°√∑’ˇ°’ˬ«¢âÕ߬—ߢ“¥§«“¡√Ÿâ§«“¡‡¢â“„®„π°“√‡§≈◊ËÕπ¬â“¬ºŸâ∫“¥‡®Á∫ ·≈–°“√¥Ÿ·≈‡∫◊ÈÕßµâπ ´÷ËßÕ“®∑”„À⇰‘¥°“√∫“¥‡®Á∫¢Õ߉¢ —πÀ≈—ß´È”´âÕπ °“√∫”∫—¥√—°…“„πªí®®ÿ∫—π¬—߉¡à ‡ªìπ‰ª„π·π«∑“߇¥’¬«°—π ¢÷ÈπÕ¬Ÿà°—∫§«“¡√Ÿâ§«“¡ “¡“√∂·≈–∑√—欓°√∑’Ë¡’Õ¬Ÿà¢Õß·µà≈–Àπ૬ߓπ ¥â«¬§«“¡µ√–Àπ—°∂÷ߪí≠À“π’È √“™«‘∑¬“≈—¬»—≈¬·æ∑¬å·Ààߪ√–‡∑»‰∑¬ √“™«‘∑¬“≈—¬ÕÕ√å‚∏ªî¥‘° å·Ààß ª√–‡∑»‰∑¬  ¡“§¡ª√– “∑»—≈¬»“ µ√å·Ààߪ√–‡∑»‰∑¬ §≥–·æ∑¬»“ µ√å¡À“«‘∑¬“≈—¬µà“ßÊ ·≈–  ∂“∫—πª√– “∑«‘∑¬“ ®÷߉¥â√à«¡°—π®—¥∑”·π«∑“ß°“√√—°…“°“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ  ”À√—∫·æ∑¬å ·≈–∫ÿ§≈“°√∑’ˇ°’ˬ«¢âÕß ‡æ◊ËÕ𔉪ªØ‘∫—µ‘„À⇪ìπ·π«∑“߇¥’¬«°—π ·≈–™à«¬„Àâ°“√„™â∑√—欓°√‡ªìπ‰ªÕ¬à“ß ‡À¡“– ¡‡°‘¥ª√–‚¬™πå Ÿß ÿ¥ ∑”„À⺟â∫“¥‡®Á∫‰¥â√—∫°“√√—°…“Õ¬à“ß∂Ÿ°µâÕß·≈–∑—π∑à«ß∑’ ≈¥§«“¡ Ÿ≠‡ ’¬∑’Ë®– ‡°‘¥µ“¡¡“ §≥–ºŸ®â ¥— ∑” ‡¡…“¬π 2548 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 9 (iv) .§”π” ºŸ∑â Ë’‰¥â√∫— ∫“¥‡®Á∫¢Õß°√–¥Ÿ° —πÀ≈—߇π◊ÕË ß®“°Õÿ∫µ— ‡‘ Àµÿ «à π„À≠à‡ªìπ§πÀπÿ¡à  “«„π«—¬∑”ß“π °“√∫“¥‡®Á∫ ¢Õß°√–¥Ÿ° —πÀ≈—ß à«π§Õ¡’Õÿ∫—µ‘°“√≥å√âÕ¬≈– 1.4.

.

 “√∫—≠ Àπâ“ §”π‘¬¡ (i) √“¬π“¡§≥–ºŸâ®—¥∑” (ii) √“¬π“¡§≥–∑”ß“π (iii) §”π” (iv) ∫∑π” 1 ∫∑∑’Ë 1 §”·π–π” ”À√—∫Àπ૬°Ÿâ™’æ„π°“√¥Ÿ·≈‡∫◊ÈÕßµâπ·°àºŸâ∑’Ë ß —¬«à“ ¡’°“√∫“¥‡®Á∫¢Õß°√–¥Ÿ° —πÀ≈—ß à«π§Õ ≥ ∑’ˇ°‘¥‡Àµÿ ·≈–°“√π” àßµàÕ‚√ß欓∫“≈ 3 ∫∑∑’Ë 2 ·π«∑“ß°“√∫”∫—¥√—°…“°“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 5 ‡Õ° “√Õâ“ßÕ‘ß 9 ¿“§ºπ«° 1. °“√‡§≈◊ËÕπ¬â“¬ºŸâªÉ«¬·≈–°“√®”°—¥°“√‡§≈◊ËÕπ‰À«¢Õß°√–¥Ÿ° —πÀ≈—ß à«π§Õ 3. ºŸâªÉ«¬∑’Ë ß —¬¡’°“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 2. °“√∂à“¬¿“æ√—ß ’„πºŸâªÉ«¬∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 12 13 18 .

 “√∫—≠·ºπ¿Ÿ¡‘ Àπâ“ ·ºπ¿Ÿ¡‘∑’Ë 1 §”·π–π” ”À√—∫Àπ૬°Ÿâ™’æ„π°“√¥Ÿ·≈‡∫◊ÈÕßµâπ·°àºŸâ∑’Ë ß —¬«à“ ¡’°“√∫“¥‡®Á∫¢Õß°√–¥Ÿ° —πÀ≈—ß à«π§Õ ≥ ∑’ˇ°‘¥‡Àµÿ ·≈–°“√π” àßµàÕ‚√ß欓∫“≈ 3 ·ºπ¿Ÿ¡‘∑’Ë 2 ·π«∑“ß°“√∫”∫—¥√—°…“°“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ (Guidelines for Management of Cervical Spine Injury) 5 .

 “√∫—≠µ“√“ß Àπâ“ µ“√“ß∑’Ë 1 √–¥—∫§”·π–π”Ցߧÿ≥¿“æ (Strength of Recommendation) µ“¡À≈—°∞“π∑“ß«‘™“°“√ 1 µ“√“ß∑’Ë 2 çABCSé checklist for the cervical spine trauma patients 19 .

14 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ .

7-4. C (µ“√“ß∑’Ë 1) ‡π◊ÈÕÀ“¢Õß·π«∑“ß°“√√—°…“°“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß  à«π§Õ©∫—∫π’Ȫ√–°Õ∫¥â«¬ ·ºπ¿Ÿ¡‘ §”Õ∏‘∫“¬ ‡Õ° “√Õâ“ßÕ‘ß µ“√“ß ·≈–¿“§ºπ«° µ“√“ß∑’Ë 1 √–¥—∫§”·π–π”Ցߧÿ≥¿“æ (Strength of Recommendation) µ“¡À≈—°∞“π∑“ß«‘™“°“√ Grade Recommendation A supported by data from randomized controlled trials with low false-positive and low false-negative errors B supported by data from randomized controlled trials with high false-positive and high false-negative errors C supported by data from non-randomized cohort studies.3 ¢Õß Õÿ∫—µ‘‡Àµÿ∑—ÈßÀ¡¥1-4 √âÕ¬≈– 71 ‡°‘¥®“°Õÿ∫—µ‘‡Àµÿ∑“ß°“√®√“®√5 ·≈–√âÕ¬≈– 27 ¡’°“√∫“¥‡®Á∫¢Õ߉¢ —πÀ≈—ß (spinal cord injury) √à«¡¥â«¬5 ∑”„Àâ Ÿ≠‡ ’¬™’«‘µÀ√◊Õ‡°‘¥§«“¡æ‘°“√µ≈Õ¥™’«‘µ  √â“ߧ«“¡∑ÿ°¢å∑√¡“π„Àâ ∑—ÈߺŸâ∫“¥‡®Á∫·≈–‡ªìπ¿“√–¢Õߧ√Õ∫§√—« °“√¥Ÿ·≈ºŸâ∫“¥‡®Á∫°≈ÿà¡π’ȇ°’ˬ«¢âÕß°—∫∫ÿ§≈“°√À≈“¬Àπ૬ߓπ À≈“¬√–¥—∫ ‡™àπ ·æ∑¬åºŸâ‡™’ˬ«™“≠‡©æ“–∑“ß ·æ∑¬å∑—Ë«‰ª 欓∫“≈ ‡®â“Àπâ“∑’˙૬‡À≈◊ÕºŸâ∫“¥‡®Á∫¢Õß Àπ૬°Ÿâ™’æµà“ßÊ ´÷Ëßæ∫«à“¬—ß¡’°“√ªØ‘∫—µ‘∑’ˉ¡à‡ªìπ‰ª„π·π«∑“߇¥’¬«°—π ¢÷ÈπÕ¬Ÿà°—∫§«“¡√Ÿâ§«“¡ “¡“√∂·≈– ∑√—欓°√∑’Ë¡’Õ¬Ÿà¢Õß·µà≈–Àπà«¬ß“π °“√®—¥∑”·π«∑“ß°“√√—°…“°“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õπ’È ¡’®ÿ¥ª√– ß§å‡æ◊ËÕ„À⺟â∑’ˇ°’ˬ«¢âÕß π”‰ªªØ‘∫—µ‘‰¥âÕ¬à“߇À¡“– ¡·≈–‡ªìπ·π«∑“߇¥’¬«°—π Õπ÷Ëß °“√®—¥∑”·π«∑“ß°“√√—°…“°“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õπ’ȉ¥âÕâ“ßÕ‘ßÀ≈—°∞“π∑“ß«‘™“°“√∑’ˉ¥â µ’æ‘¡æåÀ√◊Õ‡º¬·æ√à·≈â« ‚¥¬·∫àß√–¥—∫§”·π–π”Ցߧÿ≥¿“æ (strength of recommendation) µ“¡À≈—°∞“π ∑“ß«‘™“°“√ ‡ªìπ 3 √–¥—∫ §◊Õ A. expert opinion or consensus ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 1 .∫∑π” °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ (Cervical spine injury) ¡’Õÿ∫—µ‘°“√≥å√âÕ¬≈– 1. case report. B. case series.

2 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ .

√Ÿâ ÷°µ—«¥’  ◊ËÕ “√‰¥â∂Ÿ°µâÕß (‰¡à¡’Õ“°“√¡÷π‡¡“ ÿ√“À√◊Õ‡ æ “√ÕÕ°ƒ∑∏‘ϵàÕ®‘µª√– “∑)  “¡“√∂‡§≈◊ËÕπ‰À«»’√…–·≈–§Õ∑ÿ°∑‘»∑“ߥ⫬µπ‡Õ߉¥âµ“¡ª°µ‘ ‚¥¬‰¡à‡®Á∫ª«¥ ‰¡à¡’ à«π„¥ à«πÀπ÷ËߢÕß·¢π¢“ÕàÕπ·√ßÀ√◊Õ™“ ¬◊π À√◊Õ‡¥‘π À√◊Õπ—Ë߉¥âª°µ‘ ‚¥¬‰¡à¡’§«“¡‡®Á∫ª«¥¢ÕßÀπâ“Õ° ™àÕß∑âÕß À√◊Õ·¢π¢“ ▼ ▼ ∂â“¢“¥¢âÕ„¥¢âÕÀπ÷Ëß„Àâ ß —¬«à“ ¡’°“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ µâÕß¡’§√∫∑ÿ°¢âÕ ▼ ▼ „ àÕÿª°√≥å®”°—¥°“√‡§≈◊ËÕπ‰À« ¢Õß°√–¥Ÿ° —πÀ≈—ß∑’Ë∫“¥‡®Á∫ ®“°π—Èπ„Àâπ” àß‚√ß欓∫“≈ ¥Ÿ¿“§ºπ«° 2 ‰¡à®”‡ªìπµâÕß„ àÕÿª°√≥å ®”°—¥°“√‡§≈◊ËÕπ‰À«¢Õß°√–¥Ÿ° —πÀ≈—ß „Àâπ” àß‚√ß欓∫“≈ À¡“¬‡Àµÿ ·ºπ¿Ÿ¡‘π’È·æ∑¬åºŸâ‡°’ˬ«¢âÕßÕ“®®–𔉪„™â„π°“√®—¥Õ∫√¡·≈–·π–𔇮â“Àπâ“∑’˪√–®” √∂欓∫“≈¢ÕßÀπ૬ߓπ ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 3 . 3. 4.∫∑∑’Ë 1 §”·π–π” ”À√—∫Àπ૬°Ÿâ™’æ„π°“√¥Ÿ·≈‡∫◊ÈÕßµâπ·°àºŸâ∑’Ë ß —¬«à“¡’°“√∫“¥‡®Á∫ ¢Õß°√–¥Ÿ° —πÀ≈—ß à«π§Õ ≥ ∑’ˇ°‘¥‡Àµÿ ·≈–°“√π” àßµàÕ‚√ß欓∫“≈ µ“¡·ºπ¿Ÿ¡‘∑’Ë 1 ¥—ßµàÕ‰ªπ’È ºŸâ∫“¥‡®Á∫ ≥ ∑’ˇ°‘¥‡Àµÿ ▼ ‡°≥±å°“√ª√–‡¡‘πºŸâ∫“¥‡®Á∫ 1. 2.

§”Õ∏‘∫“¬·ºπ¿Ÿ¡‘∑’Ë 1 ºŸâ ∑’Ë ‰¥â√—∫∫“¥‡®Á∫∑’Ë∫√‘‡«≥°√–¥Ÿ° —πÀ≈—ß à«π§Õ À“°‰¥â√—∫°“√‡§≈◊ËÕπ¬â“¬‰¡à∂Ÿ°µâÕß Õ“®∑”„Àâ ‡°‘¥°“√∫“¥‡®Á∫¢Õ߉¢ —πÀ≈—߇æ‘Ë¡¢÷Èπ6-8 ®“°√“¬ß“πæ∫«à“ √âÕ¬≈– 3-25 ¢ÕߺŸâ∫“¥‡®Á∫¢Õ߉¢ —πÀ≈—ß (spinal cord injury)5.9-11 ‡°‘¥®“°°“√‡§≈◊ËÕπ¬â“¬‰¡à∂Ÿ°µâÕß ·≈–ºŸâ∫“¥‡®Á∫®”π«πÀπ÷ËßµâÕß°≈“¬‡ªìπ§πæ‘°“√ À√◊Õ‡ ’¬™’«µ‘ °“√¥Ÿ·≈ºŸâ∫“¥‡®Á∫∑’Ë∂Ÿ°µâÕß„Àâ‡√‘Ë¡µ—Èß·µà ≥ ∑’ˇ°‘¥‡Àµÿ §«√ª√–‡¡‘πºŸâ∫“¥‡®Á∫∑ÿ°√“¬«à“√Ÿâ ÷°µ—«¥’  ◊ËÕ “√ ‰¥â∂°Ÿ µâÕß ‰¡à¡Õ’ “°“√¡÷π‡¡“ ÿ√“À√◊Õ‡ æ “√ÕÕ°ƒ∑∏‘µÏ Õà ®‘µª√– “∑  “¡“√∂‡§≈◊ÕË π‰À«»’√…–·≈–§Õ∑ÿ°∑‘»∑“ß ¥â«¬µπ‡Õ߉¥âµ“¡ª°µ‘ ‚¥¬‰¡à‡®Á∫ª«¥ ‰¡à¡ ’ «à π„¥ à«πÀπ÷ßË ¢Õß·¢π¢“ÕàÕπ·√ßÀ√◊Õ™“  “¡“√∂¬◊πÀ√◊Õ‡¥‘πÀ√◊Õ π—Ë߉¥âª°µ‘ ‚¥¬‰¡à¡’§«“¡‡®Á∫ª«¥¢ÕßÀπâ“Õ° ™àÕß∑âÕß À√◊Õ·¢π¢“ ∂⓺Ÿâ∫“¥‡®Á∫‰¡à “¡“√∂∑”‰¥â∑ÿ°¢âÕ ¥—ß°≈à“«¢â“ßµâπ À√◊ÕºŸâª√–‡¡‘π‰¡à·πà „® „Àâ∂◊Õ«à“¡’°“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ®”‡ªìπ µâÕß„ àÕÿª°√≥å ®”°—¥°“√‡§≈◊ËÕπ‰À«¢Õß°√–¥Ÿ° —πÀ≈—ß∑’Ë∫“¥‡®Á∫‡ ¡Õ (¥Ÿ¿“§ºπ«° 2) °àÕπ∑’Ë®–π” àß‚√ß欓∫“≈  ”À√—∫ºŸâ∫“¥‡®Á∫∑’Ë√Ÿâ ÷°µ—«¥’  ◊ËÕ “√‰¥â∂Ÿ°µâÕß ‰¡à¡’Õ“°“√¡÷π‡¡“ ÿ√“À√◊Õ‡ æ “√ÕÕ°ƒ∑∏‘ϵàÕ®‘µª√– “∑  “¡“√∂‡§≈◊ÕË π‰À«»’√…–·≈–§Õ∑ÿ°∑‘»∑“ߥ⫬µπ‡Õ߉¥âµ“¡ª°µ‘ ‚¥¬‰¡à‡®Á∫ª«¥ ‰¡à¡ ’ «à π„¥ à«πÀπ÷ßË ¢Õß·¢π ¢“ÕàÕπ·√ßÀ√◊Õ™“  “¡“√∂¬◊πÀ√◊Õ‡¥‘πÀ√◊Õπ—ßË ‰¥âª°µ‘ ‚¥¬‰¡à¡§’ «“¡‡®Á∫ª«¥¢ÕßÀπâ“Õ° ™àÕß∑âÕß À√◊Õ·¢π¢“ °√≥’‡™àππ’ȉ¡à®”‡ªìπµâÕß„ àÕÿª°√≥å®”°—¥°“√‡§≈◊ËÕπ‰À«¢Õß°√–¥Ÿ° —πÀ≈—ß°àÕππ” àß‚√ß欓∫“≈ 4 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ .

∂â“®”‡ªìπÕ“®‡æ‘Ë¡ AP. obtunded ë Evidence of intoxication ▼ Symptomatic Rx ▼ ▼ GCS≤13 ▼ Discharge & advice ▼ GCS≥14 ▼ Close observati on Plain X-ray of cervical spine: cross-table lateral viewD ▼ Not Improved / worse ▼ No ë Fracture / dislocation / abnormal prevertable soft tissue shadow ▼ Improved Yes ▼ Re-evaluation for suspected cervical spine injury as aboveA ▼ Plain X-ray of cervical spine: active cross-table lateral flexion-extension ▼ Normal ▼ Doubtful ▼ Abnormal ▼ Discontinue immobilization ▼ Discharge & advice ▼ ▼ ▼ ▼ ▼ ▼ Refer for definitive treatment NB A. „Àâ°“√√—°…“‡∫◊ÈÕßµâπ (standard resuscitation) ‡¡◊ËÕºŸâªÉ«¬Õ¬Ÿà„π ¿“«–‡À¡“– ¡ ®÷ß àßµàÕºŸâªÉ«¬æ∫·æ∑¬åºŸâ‡™’ˬ«™“≠ B. ¥Ÿ¿“§ºπ«° 1 C. Open mouth view (¥Ÿ¿“§ºπ«° 3) GCS = Glasgow Coma Score ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 5 .∫∑∑’Ë 2 ·π«∑“ß°“√∫”∫—¥√—°…“°“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ (Guidelines for Management of Cervical Spine Injury) ·ºπ¿Ÿ¡‘∑’Ë 2 Injured Patient ▼ Clinical Assessment & Initial emergency treatmentA ▼ Suspected Cervical Spine InjuryB No Yes ▼ ImmobilizationC Group I Group II Group III Group IV ▼ ▼ ▼ ▼ No imaging assessment needed ë Neurologic examination normal ë Neck pain or tenderness or limited range of motion ë Neurological deficit ë Major distracting injuries ë Unconscious. ¥Ÿ¿“§ºπ«° 2 D.

12-14 ‰¡à¡Õ’ “°“√¡÷π‡¡“ ÿ√“À√◊Õ‡ æ “√ÕÕ°ƒ∑∏‘µÏ Õà ®‘µª√– “∑ ·≈–‰¡à¡°’ “√∫“¥‡®Á∫√ÿπ·√ߢÕßÕ«—¬«–  à«πÕ◊ËπÊ ¢Õß√à“ß°“¬ ºŸâ∫“¥‡®Á∫°≈ÿà¡π’ȉ¡à®”‡ªìπµâÕß„ àÕÿª°√≥å®”°—¥°“√‡§≈◊ËÕπ‰À«°√–¥Ÿ° —πÀ≈—ß à«π§Õ ·≈–‰¡à®”‡ªìπµâÕß àßµ√«® x-ray °√–¥Ÿ° —πÀ≈—ß à«π§Õ (recommendation A) °“√∫”∫—¥√—°…“ : √—°…“µ“¡Õ“°“√ ·≈–·π–π”ºŸâªÉ«¬ °≈ÿà¡∑’Ë 2 (group II) ºŸâ∫“¥‡®Á∫√Ÿâ ÷°µ—«¥’  ◊ËÕ “√‰¥â∂Ÿ°µâÕß ·≈–‰¡à¡’Õ“°“√º‘¥ª°µ‘¢Õß√–∫∫ª√– “∑ ‰¡à¡’Õ“°“√¡÷π‡¡“ ÿ√“À√◊Õ‡ æ “√ÕÕ°ƒ∑∏‘ϵàÕ®‘µª√– “∑ ·≈–‰¡à¡’°“√∫“¥‡®Á∫√ÿπ·√ߢÕßÕ«—¬«– à«πÕ◊ËπÊ ¢Õß√à“ß°“¬ ·µà¡’Õ“°“√ª«¥À√◊Õ°¥‡®Á∫µ“¡·π«¢Õß°√–¥Ÿ° —πÀ≈—ß à«π§Õ À√◊Õ‰¡à “¡“√∂‡§≈◊ËÕπ‰À«»’√…– ·≈–§Õ‰¥âµ“¡ª°µ‘ „Àâ àßµ√«® plain x-ray cervical spine ∑à“ cross table lateral ´÷Ëß¡’§«“¡πà“‡™◊ËÕ∂◊Õ ‰¥â∂÷ß√âÕ¬≈– 93-9815 (·µà∂â“®”‡ªìπÕ“®‡æ‘Ë¡∑à“ AP ·≈– Open mouth)15-16 º≈°“√«‘π‘®©—¬ : 1. ∂â“ plain x-ray cervical spine æ∫«à“¡’°√–¥Ÿ°À—°À√◊Õ‡§≈◊ËÕπÀ√◊Õ¡’‡ß“‡π◊ÈÕ‡¬◊ËÕ¥â“πÀπâ“ °√–¥Ÿ° —πÀ≈—ß à«π§Õ (prevertebral soft tissue shadow) Àπ“¢÷Èπº‘¥ª°µ‘ (¥Ÿ¿“§ºπ«° 3) °“√∫”∫—¥√—°…“ : „Àâª√÷°…“À√◊Õ àßµàÕ·æ∑¬åºŸâ‡™’ˬ«™“≠‡æ◊ËÕ„Àâ°“√√—°…“∑’Ë∂Ÿ°µâÕßµàÕ‰ª (recommendation C) 6 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ .§”Õ∏‘∫“¬·ºπ¿Ÿ¡‘∑’Ë 2 ·ºπ¿Ÿ¡‘∑’Ë 2 ‡ªìπ·ºπ¿Ÿ¡‘∑’Ë„™â„π°“√ªØ‘∫—µ‘µàÕ‡π◊ËÕß®“°·ºπ¿Ÿ¡‘∑’Ë 1 ‡ªìπ°“√ª√–‡¡‘π‚¥¬·æ∑¬å ´÷Ëß√—∫ ºŸâ∫“¥‡®Á∫À≈—ß®“°∑’ËÀπ૬°Ÿâ™’扥âπ” àß‚√ß欓∫“≈‡ªìπ∑’ˇ√’¬∫√âÕ¬·≈â« ·ºπ¿Ÿ¡‘π’È¡’«—µ∂ÿª√– ß§å‡æ◊ËÕ„Àâ·æ∑¬å  “¡“√∂∑”°“√«‘π‘®©—¬·≈–∫”∫—¥√—°…“‡∫◊ÈÕßµâπÕ¬à“߇ªìπ√–∫∫ µ“¡‡°≥±å∑’ˉ¥â®”·π°ºŸâ∫“¥‡®Á∫‡ªìπ°≈ÿࡵà“ßÊ ‡¡◊Ë Õ ºŸâ ‰¥â√—∫∫“¥‡®Á∫∂Ÿ°π” àß∂÷ßÀâÕß©ÿ°‡©‘π¢Õß‚√ß欓∫“≈ „π‡∫◊ÈÕßµâπ„Àâª√–‡¡‘πºŸâ∫“¥‡®Á∫µ“¡ À≈—°‡°≥±å°“√ª√–‡¡‘π·≈–√—°…“ºŸâ∫“¥‡®Á∫©ÿ°‡©‘π (standard emergency resuscitation) À≈—ß®“°„Àâ°“√√—°…“‡∫◊ÈÕßµâπ „Àâ∑”°“√ª√–‡¡‘π·≈–®”·π°ºŸâ∫“¥‡®Á∫«à“Õ¬Ÿà„π°≈ÿà¡„¥ ¥—ßµàÕ‰ªπ’È °≈ÿ¡à ∑’Ë 1 (group I) ºŸ∫â “¥‡®Á∫√Ÿ â °÷ µ—«¥’  ◊ÕË  “√‰¥â∂°Ÿ µâÕß ‰¡à¡Õ’ “°“√º‘¥ª°µ‘¢Õß√–∫∫ª√– “∑  “¡“√∂ ‡§≈◊ËÕπ‰À«»’√…–·≈–§Õ∑ÿ°∑‘»∑“߉¥â ‚¥¬‰¡àª«¥ ·≈–µ√«®‰¡àæ∫«à“¡’°“√°¥‡®Á∫µ“¡·π«¢Õß°√–¥Ÿ° —πÀ≈—ß  à«π§Õ3-4.

3 ∂⓺Ÿâ∫“¥‡®Á∫¬—ß¡’Õ“°“√‡®Á∫ª«¥À√◊ÕÕ“°“√Õ◊ËπÊ ∑’Ë§Õ ·µà ‰¡à “¡“√∂ àßµ√«® x-ray „π∑à“ active (voluntary) cross-table lateral flexion-extension ‰¥â „Àâ „  à Õÿ ª °√≥å ®”°— ¥ °“√‡§≈◊ËÕπ‰À«¢Õß°√–¥Ÿ° —πÀ≈—ß à«π§ÕµàÕ‰ª ·≈–æ‘®“√≥“µ‘¥µ“¡¥Ÿ·≈√—°…“ºŸâ∫“¥‡®Á∫‡ÕßÀ√◊Õ àßµàÕ·æ∑¬å ºŸâ‡™’ˬ«™“≠ (recommendation C) 2.1 „π°√≥’º∫⟠“¥‡®Á∫∑’¡Ë Õ’ “°“√‡°√ÁߢÕß°≈â“¡‡π◊ÕÈ §Õ·≈–ª«¥§Õ¡“° ·≈–‰¡à “¡“√∂µ√«® plain x-ray cervical spine ∑à“ active (voluntary) cross-table lateral flexion-extension17-19 ‰¥â °“√∫”∫—¥√—°…“ : „Àâ„ àÕÿª°√≥å®”°—¥°“√‡§≈◊ËÕπ‰À«¢Õß°√–¥Ÿ° —πÀ≈—ß à«π§Õ ·π–π”„À⺟â∫“¥‡®Á∫À≈’°‡≈’Ë¬ß °‘®°√√¡‡ ’ˬߵàÕÕÿ∫—µ‘‡Àµÿª√–¡“≥ 7-10 «—π20 ·≈–‡¡◊ËÕºŸâ∫“¥‡®Á∫°≈—∫¡“µ√«®µ“¡π—¥ 2.1.2 „π°√≥’ºŸâªÉ«¬∑’Ë¡’Õ“°“√‡°√ÁߢÕß°≈â“¡‡π◊ÈÕ§ÕÀ√◊Õª«¥§Õ‰¡à¡“° „Àâ àßµ√«® plain x-ray cervical spine ∑à“ active cross table lateral flexion-extension ‡æ◊ËÕ¥Ÿ«à“¡’°√–¥Ÿ° —πÀ≈—ß à«π§Õº‘¥ª°µ‘ À√◊Õ‰¡à °“√∫”∫—¥√—°…“ : 2.2 ∂⓺Ÿâ∫“¥‡®Á∫¬—ß¡’Õ“°“√‡®Á∫ª«¥À√◊ÕÕ“°“√Õ◊ËπÊ ∑’Ë§Õ „Àâ àßµ√«® plain x-ray cervical spine ∑à“ active (voluntary) cross-table lateral flexion-extension (∂Õ¥Õÿª°√≥å®”°—¥°“√ ‡§≈◊ËÕπ‰À«¢Õß°√–¥Ÿ° —πÀ≈—ß à«π§ÕÕÕ°·≈–„À⺟âªÉ«¬°â¡ .1.∂⓺≈ x-ray ª°µ‘‰¡à®”‡ªìπµâÕß„ àÕÿª°√≥å®”°—¥°“√‡§≈◊ËÕπ‰À«°√–¥Ÿ° —πÀ≈—ß  à«π§Õ·≈–·π–π”°“√ªØ‘∫—µ‘µ—«µàÕºŸâ∫“¥‡®Á∫ (recommendation C) . ∂â“ plain x-ray ‰¡àæ∫§«“¡º‘¥ª°µ‘„¥Ê „π¢âÕ 1 „Àâæ‘®“√≥“¥—ßπ’È 2.‡ß¬»’√…–·≈–§Õ¥â«¬µπ‡Õß) .1.1 ∂â “ ºŸâ ∫ “¥‡®Á ∫ ‰¡à ¡’ Õ “°“√‡®Á ∫ ª«¥À√◊ Õ Õ“°“√Õ◊Ë π Ê ∑’Ë § Õ „Àâ ∂ Õ¥Õÿ ª °√≥å ®”°— ¥ °“√‡§≈◊ËÕπ‰À«°√–¥Ÿ° —πÀ≈—ß à«π§Õ·≈–·π–π”°“√ªØ‘∫—µ‘µ—«µàÕºŸâ∫“¥‡®Á∫ (recommendation C) 2.2 ∂Ⓣ¡àæ∫°√–¥Ÿ° —πÀ≈—ß à«π§Õº‘¥ª°µ‘À√◊Õ‡§≈◊ËÕπ ‰¡à®”‡ªìπµâÕß„ àÕÿª°√≥å®”°—¥ °“√‡§≈◊ËÕπ‰À«¢Õß°√–¥Ÿ° —πÀ≈—ß à«π§Õ ·≈–·π–π”°“√ªØ‘∫—µ‘µ—«µàÕºŸâ∫“¥‡®Á∫ (recommendation C) ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 7 .1 ∂â “ ¡’ ° √–¥Ÿ °  — π À≈— ß  à « π§Õº‘ ¥ ª°µ‘ À √◊ Õ ‡§≈◊Ë Õ πÀ√◊ Õ ‰¡à · πà „ ® „Àâ „  à Õÿ ª °√≥å ®”°— ¥ °“√‡§≈◊Ë Õ π‰À«¢Õß°√–¥Ÿ °  — π À≈— ß  à « π§Õ ·≈–æ‘ ® “√≥“ª√÷ ° …“À√◊ Õ  à ß µà Õ ·æ∑¬å ºŸâ ‡ ™’Ë ¬ «™“≠ (recommendation C) 2.∂⓺≈ x-ray º‘¥ª°µ‘ À√◊Õ‰¡à·πà „® À√◊Õ ß —¬ „Àâª√÷°…“À√◊Õ àßµàÕ·æ∑¬å ºŸâ‡™’ˬ«™“≠ (recommendation C) 2.2.2.2.

incommunicable) À√◊Õ¡’ Õ“°“√¡÷π‡¡“ ÿ√“À√◊Õ‡ æ “√ÕÕ°ƒ∑∏‘µÏ Õà ®‘µª√– “∑ (intoxication) ®π‰¡à “¡“√∂∫Õ°∂÷ßÕ“°“√‡®Á∫ª«¥∑’§Ë Õ‰¥â ·≈–‰¡à¡’·¢π¢“ÕàÕπ·√ßÀ√◊Õ¡’°“√∫“¥‡®Á∫∑’Ë√ÿπ·√ߢÕßÕ«—¬«–Õ◊ËπÊ (distracting injury. ∂⓺ŸâªÉ«¬¡’ GCS ≥ 14 °≈ÿà¡π’ȵâÕ߇ΩÑ“√–«—ß°“√‡ª≈’ˬπ·ª≈ß∑’ËÕ“®‡°’ˬ«¢âÕß°—∫°“√∫“¥‡®Á∫∑’Ë»’√…– °“√∫”∫—¥√—°…“ : „À⠗߇°µÕ“°“√Õ¬à“ß„°≈♑¥ ‚¥¬ 1. ∂⓺ŸâªÉ«¬¡’ GCS ≤ 13 °“√∫”∫—¥√—°…“ : „Àâ°“√√—°…“‡∫◊ÈÕßµâπ°àÕπ (airway. breathing. circulation) ‡¡◊ËÕºŸâªÉ«¬Õ¬Ÿà„π  ¿“«–‡À¡“– ¡ ®÷ߪ√÷°…“À√◊Õ àßµàÕ·æ∑¬åºŸâ‡™’ˬ«™“≠ (recommendation C) 8 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ .1 ∂â“Õ“°“√¥’¢÷Èπ  ◊ËÕ “√‰¥â∂Ÿ°µâÕß „Àâ∑”°“√ª√–‡¡‘π„À¡à«à“‡¢â“‰¥â°—∫°≈ÿࡉÀπ ·≈–„Àâ °“√∫”∫—¥√—°…“µ“¡·π«∑“ߢÕß°≈ÿà¡π—ÈπÊ (recommendation C) 1.°≈ÿà¡∑’Ë 3 (group III) ºŸâ∫“¥‡®Á∫∑’Ë√Ÿâ ÷°µ—«  ◊ËÕ “√‰¥â∂Ÿ°µâÕß ·µà¡’§«“¡º‘¥ª°µ‘¢Õß√–∫∫ª√– “∑ (Neurological deficit) ‡™àπ ·¢π¢“ÕàÕπ·√ßÀ√◊Õ¡’Õ“°“√™“ à«π„¥ à«πÀπ÷ËߢÕß√à“ß°“¬ ‡ªìπµâπ À√◊Õ ºŸâ∫“¥‡®Á∫∑’Ë¡’°“√∫“¥‡®Á∫∑’Ë√ÿπ·√ߢÕßÕ«—¬«–Õ◊ËπÊ (distracting injury. multiple injury) „ÀâªØ‘∫—µ‘¥—ßπ’È 1.2 ∂â“Õ“°“√‡≈«≈ßÀ√◊Õ‰¡à¥’¢÷Èπ „Àâª√÷°…“À√◊Õ àßµàÕ·æ∑¬åºŸâ‡™’ˬ«™“≠ (recommendation C) 2. multiple injury) ®π‰¡à “¡“√∂∫Õ°∂÷ß Õ“°“√‡®Á∫ª«¥∑’˧Չ¥â °“√∫”∫—¥√—°…“ : „Àâ°“√√—°…“‡∫◊ÈÕßµâπ°àÕπ (airway. breathing. circulation) ‡¡◊ËÕºŸâ∫“¥‡®Á∫Õ¬Ÿà „π ¿“«–‡À¡“– ¡ ®÷ߪ√÷°…“À√◊Õ àßµàÕ·æ∑¬åºŸâ‡™’ˬ«™“≠‡æ◊ËÕ„Àâ°“√√—°…“∑’Ë∂Ÿ°µâÕßµàÕ‰ª (recommendation C) À¡“¬‡Àµÿ „π°√≥’∑’Ë “¡“√∂®–∑”°“√ x-ray °√–¥Ÿ° —πÀ≈—ß à«π§Õ‰¥â „Àâ∑” x-ray °àÕπ àßµàÕ °≈ÿà¡∑’Ë 4 (group IV) ºŸâ∫“¥‡®Á∫∑’ˉ¡à√Ÿâ ÷°µ—«  ◊ËÕ “√‰¡à‰¥â (unconscious.

Spial Cord 1999. J Trauma 1987. 47: 684-90. Maynard FM: Stabilization of spinal injury for early tranfer. 9. Reilly PM. Phreaner DL. 7. Todd KH. 4. Mower WR. Simon RR. Hoffman JR. JAMA 2001. Sugarman DB: Respiratory effects of spinal immolization. 34: 342-6.: The Canadian C-spine Rule for radiography in alert and stable trauma patients.‡Õ° “√Õâ“ßÕ‘ß 1. 3: 1-6. Rockswold GL: Neurologic recovery following rapid spinal realignment for complete cervical spinal cord injury. Schwartz A. Stiel IG. Zucker MI: Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. Prehosp Emerg Care 1999. Mackersie RC: The etiology of missed cervical spine injuries. Gillett T. Hoyt DB. Brunette DD. Podolsky S. N Eng J Med 2000. 10. 11. Wittwer LK: Paramedic use of a spinal injury clearance algolithm reduces spinal immobilization in out-of-hospital setting. Drummond JC: Care of the multiply injured patient with cervical spine injury. Sharkey PW. J Trauma 1989. 27: 445-7. Marshall LF. Prehosp Emerg Care 1999. 23: 461-5.S. Larmon B. 2. Seabrook DL. ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 9 . De Maio VJ et al. 29: 1497-9. Waggoner R. 343: 94-9. Garfin SR. 286: 1841-8. J Trauma 1993. Wells GA. Grossman MD. Vandemheen KL. Muhr MD. 37: 560-8. Schwartz ML: Characteristics of injuries to the cervical spine and spinal cord in polytrauma patient population: Experience from a regional trauma unit. Totten VY. National Emergency X-Radiography Utilization Study Group. Bhutani R. 3. trauma centers. 3: 347-52. 8. Ablon W : Efficacy of cervical spine immobilization methods. Wolfson AB. Hoffman JR. 6. Davis JW. Prasad VS. J Trauma 1999. 5. J Trauma 1983. Gillett D: National survey of the incidence of cervical spine injury and approach to cervical spine clearance in U. Burney RE. Shackford SR. Clement CM. Baraff LJ. 239: 19-29. Clin Orthop 1989. Lesiuk H.

Barton R: Optimal positioning for cervical immobilization. Theodorou D. 18: 818-21. 22.Nelson WR: Diagnosis of cervical spine injury in motor vehicle crash victims: how many X-rays are enough? J Trauma 1990. Tully EA. Edwards MJ. Joslyn JN. 20: 117-21. van Vugt AB: Routine cervical spine radiography for trauma victims: does everybody need it? J Trauma 2001. 20. Augustine J. Cassar Pullicino: Imaging of acute cervical spine injuries: review and outlook. Cornwell EE 3rd. Exline C. Piche J. Frankema SP. Gutteridge GA: How should an unconscious person with a suspected neck injury be positioned? Prehospital Disaster Med 1995. Kruit MC. 17: 504-8. Britton P: Flexion-extension views in the evaluation of cervical spine injuries. Olson JE. Sharkey PW. Belzberg H. 30: 392-7. 170: 831-4. Gunn DB. Williams J : Comparison of five-view and three-view cervical spine series in the evaluation of patients with cervical trauma. Young J: ED use of flexion-extension cervical spine radiography in the evaluation of blunt trauma. Freemyer B. 40: 768-74.Scheinkestel CD. Fortney JP. Brady WJ. Mirich D. B. Militello P : Protocol driven radiologic evaluation of suspected cervical spine injury: Efficacy study. Radiology 1989. Tatevossian R. Brown DJ. 17. Wales L. Hamilton GC. J Trauma 1996. Moghtader J.Ruoff BE. Diaconis JN. McMeekan JM. 15. Mirvis SE. 59: 865-80. 50: 529-34. 18. Knopp R. Clinical Radiology 2004. Eizenberg N. Laidlaw J. Am J Emerg Med 1999. De Lorenzo RA. Ann Emerg Med 1989. Ann Emerg Med 1996. Breslau PJ. Stillman BC. : Radiography cervical spine evaluation in the alert asymptomatic blunt trauma victim: much ado about nothing. 16. Docherty M. Boska M. 21. Schwartz ML. Silberstein M.N. 28: 301-8. Ajani AE. Tins and V. 10: 239-44. 10 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ . Lewis LM. Chirico PA. 19. 14. 13. Tuxen DV:Optimal assessment of cervical spine trauma in critically ill patient: A prospective evaluation. Reiner BI. Berne TV et al. Ann Emerg Med 1991.12.Cutcher D. Johnson R.J. Anaesth Intensive Care 1998. Velmahos GC. Keltner RA Jr. Cooper DJ. 26: 487-91. MacDonald RL.

25. 23: 208-11. Herr CH. Havel CJ : Utility of prevertebral soft tissue measurements in identifying patients with cervical spine fractures. 24: 1119-24.23. Ann Emerg Med 1994. Am J Emerg Med 1998. Treloar D : Neutral cervical spine positioning in children. Debehnke DJ. 16: 346-9. 24. Ann Emerg Med 1994. ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 11 . Ball PA. Nypaver M. Quinton HB: Sensitivity of prevertebral soft tissue measurement of C3 for detection of cervical spine fractures and dislocations. Sargent SK.

The absence of tenderness at the posterior midline of cervical spine 2. Persons who can actively turn their heads by 45 Ì in both directions do not need to undergo imaging of the cervical spine. being hit by a bus) ë Sitting position in the emergency department ë Ambulatory at any time ë Delayed onset at neck pain (i. No evidence of intoxication 5. motor vehicle accident. A normal level of alertness 4. not immediate onset of neck pain) ë Absence of midline C-spine tenderness 3. 12 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ . axial load to the head (e.¿“§ºπ«° 1 ºŸâªÉ«¬∑’Ë ß —¬¡’°“√∫“¥‡®Á∫¢Õß°√–¥Ÿ° —πÀ≈—ß à«π§Õ (Patient Suspected of Cervical Spine Injury) ªí®®ÿ∫π— π‘¬¡„™â‡°≥±å°“√ª√–‡¡‘πºŸªâ «É ¬∑’ Ë ß —¬¡’°“√∫“¥‡®Á∫¢Õß°√–¥Ÿ° —πÀ≈—ß à«π§Õ¢Õß Õß ∂“∫—π §◊Õ National Emergency X-Radiography Utilization Study (NEXUS criteria) °—∫ Canadian C-spine Rule (CCR) ´÷Ëß®–„™â¢Õß ∂“∫—π‰Àπæ‘®“√≥“µ“¡§«“¡‡À¡“– ¡ The NEXUS Criteria4 1. diving).g. High risk criteria for cervical spine injury.e. The absence of focal neurologic deficit 3. requiring imaging. Absence of clinically apparent pain that might distract the patient from the pain of a cervical-spine injury ∂⓺ŸâªÉ«¬Õ¬Ÿà„π‡°≥±å§√∫∑—Èß 5 ¢âÕ · ¥ß«à“¡’§«“¡‡ ’ˬßπâÕ¬∑’Ë®–¡’°“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ Canadian C-spine Rule (CCR)1 1. ë Age ≥ 65 years ë Dangerous mechanism of injury: fall from 1 m (5 stairs) or higher. ë Paraesthesia in extremities 2. Low risk criteria for assessment active range of motion ë Simple rear end motor vehicle collision (this excludes: being pushed into oncoming traffic.

multihand or fireman lift method 1.¿“§ºπ«° 2 °“√‡§≈◊ËÕπ¬â“¬ºŸâªÉ«¬·≈–°“√®”°—¥°“√‡§≈◊ËÕπ‰À«¢Õß°√–¥Ÿ° —πÀ≈—ß à«π§Õ (Transportation and Immobilization of Cervical Spine Injury) °“√‡§≈◊ËÕπ¬â“¬ºŸâªÉ«¬∑’Ë ß —¬¡’°“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ ºŸâªÉ«¬∑’Ë ß —¬¡’°“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ ®–µâÕß∑”°“√‡§≈◊ËÕπ¬â“¬‡ ¡◊ÕπºŸâªÉ«¬∑’Ë¡’°“√∫“¥‡®Á∫ °√–¥Ÿ° —πÀ≈—ß à«π§Õ‡ ¡Õ §«√„ à rigid cervical orthosis À√◊ÕÕÿª°√≥å„°≈⇧’¬ß∑’Ë “¡“√∂π”¡“∑¥·∑π °—π‰¥â °àÕπ°“√‡§≈◊ËÕπ¬â“¬‡ ¡Õ (recommendation C) °“√‡§≈◊ËÕπ¬â“¬¡’À≈“¬«‘∏’ ‡™àπ log roll (lateral recovery position). «‘∏’ log roll ‡ªìπ«‘∏’∑’Ë„™â¡“π“π ë ºŸâ™à«¬‡À≈◊ÕÕ¬à“ßπâÕ¬ 2 §π §πÀπ÷ËßÕ¬Ÿà∑“ߥâ“π»’√…– §π∑’ˇÀ≈◊ÕÕ¬Ÿà∑“ߥâ“π¢â“ßÊ ‡¥’¬«°—π ¢ÕߺŸªâ «É ¬ ë ºŸâ∑’ËÕ¬Ÿà¥â“π»’√…– „™â¡◊Õ Õߢâ“ß®—∫°√“¡ Õߢâ“ߢÕߺŸâªÉ«¬ ·≈â«¥÷߇¢â“À“µ—« ¢≥–‡¥’¬«°—π§π ∑’ˇÀ≈◊Õ„Àâ™à«¬®—∫À—«‰À≈à ≈”µ—« ·¢π ¢“ ¥â“πµ√ߢⓡ ®“°π—Èπ∑”°“√æ≈‘°ºŸâªÉ«¬∑—Èßµ—« æ√âÕ¡Ê °—π ‡æ◊ËÕ„À⺟âªÉ«¬Õ¬Ÿà„π∑à“µ–·§ßµ—« ‚¥¬√—°…“µ”·ÀπàߢÕß°√–¥Ÿ° —πÀ≈—ß„ÀâÕ¬Ÿà „π ·π«µ√ßµ≈Õ¥‡«≈“ ë π” long backboard  Õ¥‡¢â“„µâ»’√…– ≈”µ—« ·≈–¢“ Õߢâ“ß ë æ≈‘°ºŸâªÉ«¬∑—Èßµ—«æ√âÕ¡Ê °—π „À⺟âªÉ«¬°≈—∫¡“∑à“πÕπÀß“¬∫π long backboard ë ®”°—¥°“√‡§≈◊ËÕπ‰À«¢Õß»’√…–·≈–µâπ§Õ‚¥¬„ à rigid immobilization À¡“¬‡Àµÿ Õ“®æ‘®“√≥“„™â scoop stretcher ™à«¬„π°“√‡§≈◊ÕË π¬â“¬ºŸ∫â “¥‡®Á∫ ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 13 . HAINES (High Arm IN Endangered Spine) method.

√Ÿª∑’Ë 1 «‘∏’ Log roll 2. HAINES method ®“°°“√»÷°…“¢Õß Gunn21 æ∫«à“ °“√‡§≈◊ËÕπ¬â“¬«‘∏’ log roll ¬—ßÕ“®¡’ °“√‡§≈◊ËÕπ∑’Ë∑“ߥâ“π¢â“ߢÕß°√–¥Ÿ°µâπ§Õ ®÷߉¥â‡ πÕÕ’°«‘∏’ ‚¥¬„À⺟âªÉ«¬πÕπÀß“¬ ‡À¬’¬¥·¢πºŸâªÉ«¬ ¥â“πµ√ߢⓡ°—∫ºŸâ™à«¬‡À≈◊Õ ¢÷Èπ‰ª∑“ß»’√…– 180 Õß»“ ·¢πºŸâªÉ«¬¥â“π‡¥’¬«°—∫ºŸâ™à«¬‡À≈◊Õ«“߉«â∫πÀπâ“Õ° ‡¢à“ßÕ∑—Èß Õߢâ“ß ºŸâ™à«¬‡À≈◊Õ®—∫»’√…–·≈–µâπ§Õ„Àâ¡—Ëπ æ≈‘°µ—«ºŸâªÉ«¬æ√âÕ¡Ê °—π „ÀâÕ¬Ÿà„π∑à“µ–·§ß ·≈â«  Õ¥ long backboard ‡¢â“„µâ»’√…– µâπ§Õ ≈”µ—« ¢“ Õߢâ“ß ·≈â«æ≈‘°ºŸâªÉ«¬°≈—∫¡“Õ¬Ÿà„π∑à“πÕπÀß“¬∫π long backboard ®”°—¥°“√‡§≈◊ËÕπ‰À«¢Õß»’√…–·≈–µâπ§Õ‚¥¬„ à rigid immobilization 14 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ .

Multihand or fireman lift method ‚¥¬¡’ºŸâ™à«¬‡À≈◊ÕÀ≈“¬§π ¬◊π¢π“∫ 2 ¢â“ߺŸâªÉ«¬ „™â ¡◊Õ Õ¥„µâµ—«ºŸâªÉ«¬ ®“°π—Èπ¬°ºŸâªÉ«¬¢÷Èπæ√âÕ¡°—π‡æ◊ËÕ‡§≈◊ËÕπ¬â“¬ºŸâªÉ«¬¢÷Èπ∫π long backboard ®”°—¥ °“√‡§≈◊ËÕπ‰À«¢Õß»’√…–·≈–°√–¥Ÿ° —πÀ≈—ß à«π§Õ‚¥¬„ à rigid immobilization °“√®—¥∑à“ºŸâªÉ«¬·≈–®”°—¥°“√‡§≈◊ËÕπ‰À«¢Õß»’√…–·≈–°√–¥Ÿ° —πÀ≈—ß à«π§Õ ‚¥¬„ à rigid immobilization ºŸâªÉ«¬∑ÿ°√“¬∑’Ë ß —¬¡’°“√∫“¥‡®Á∫∑’Ë°√–¥Ÿ° —πÀ≈—ß à«π§Õ ®–®”°—¥°“√‡§≈◊ËÕπ‰À«¢Õß°√–¥Ÿ° —πÀ≈—ß  à«π§Õ (immobilization) ‡ ¡◊ÕπºŸâªÉ«¬¡’°“√∫“¥‡®Á∫¢Õß°√–¥Ÿ° —πÀ≈—ß à«π§Õ ‚¥¬·π–π”„À⺟âªÉ«¬πÕπÀß“¬ ·≈–Àπÿπ∑⓬∑Õ¬„À⠟ߢ÷Èπ‡≈Á°πâÕ¬ ª√–¡“≥ 2 ´¡.22 ‡°‘¥ flexion ª√–¡“≥ 14 Õß»“ ‡æ◊ËÕ„Àâ»’√…–Õ¬Ÿà„π neutral position (recommendation C) \ √Ÿª∑’Ë 2 Neutral position ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 15 .3.

„π‡¥Á°Õ“¬ÿµË”°«à“ 10 ¢«∫ ·π–π”„À⺟âªÉ«¬πÕπÀß“¬ „ÀâÀπÿπ∫√‘‡«≥À≈—ß (back elevation)  Ÿß¢÷Èπ ‡≈Á°πâÕ¬ ª√–¡“≥ 2.5 ´¡.23 ‡æ◊ËÕ„Àâ»’√…–Õ¬Ÿà„π neutral position (recommendation C) √Ÿª∑’Ë 3 Neutral position (‡¥Á°) Rigid immobilization ∑’Ë·π–π”§◊Õ ë „ à rigid cervical orthosis ‡™àπ Philadelphia-type collar ë „À⺟âªÉ«¬πÕπ∫π long backboard ë ¡’ side head supports Õ“®„™âÀ¡Õπ∑√“¬ ¢«¥πÈ”‡°≈◊Õ «“ß Õߢâ“ߢÕß»’√…– ë ¬÷¥»’√…–µ‘¥°—∫ long backboard À√◊Õ side head supports ë ¬÷¥≈”µ—«  –‚æ° À—«‡¢à“ ¢âÕ‡∑â“ µ‘¥°—∫ long backboard 16 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ .

Cervical orthosis Side head supports √Ÿª∑’Ë 4 °“√¬÷¥≈”µ—« Àπâ“Õ° ‡Õ« À—«‡¢à“ ·≈–¢âÕ‡∑â“ ¢ÕߺŸâªÉ«¬‡¢â“°—∫ long backboard À¡“¬‡Àµÿ „π°√≥’∑’ˉ¡à¡’«— ¥ÿÕÿª°√≥套߰≈à“« Õπÿ‚≈¡„Àℙ⫗ ¥ÿÕÿª°√≥å∑’Ë„°≈⇧’¬ß·∑π‰¥â ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 17 .

atlantoaxial relationship ·≈–§«“¡Àπ“¢Õß prevertebral soft tissue ∑à“Õ◊ËπÊ ∑’Ë„™â¡’ AP.¿“§ºπ«°∑’Ë 3 °“√∂à“¬¿“æ√—ß ’ „πºŸâªÉ«¬∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ* ¿“æ√—ß ’¡’Àπâ“∑’˙૬¬◊π¬—π«à“¡’À√◊Õ‰¡à¡’¿“«–∫“¥‡®Á∫¢Õß°√–¥Ÿ° —πÀ≈—ß à«π§Õ ‰¢ —πÀ≈—ß ‡ âπª√– “∑ À≈Õ¥‡≈◊Õ¥·¥ß·≈–‡π◊ÈÕ‡¬◊ËÕ¢â“߇§’¬ß ‡æ◊Ëՙ૬„Àâ·æ∑¬å¥Ÿ·≈√—°…“ºŸâªÉ«¬°≈ÿà¡π’ÈÕ¬à“ß∂Ÿ°µâÕß ·≈–‡À¡“– ¡ ‡®â“Àπâ“∑’Ë∑’ˇ°’ˬ«¢âÕßµâÕß„™â§«“¡√–¡—¥√–«—ßÕ¬à“ß Ÿß„π°“√®—¥∑à“ºŸâªÉ«¬„π°“√∂à“¬¿“æ‡À≈à“π’È ‡æ◊ËÕªÑÕß°—π Õ—πµ√“¬∑’ËÕ“®‡°‘¥µàÕ√–∫∫ª√– “∑·≈–À≈Õ¥‡≈◊Õ¥¢â“߇§’¬ß ∂Ⓡ°‘¥°“√‡§≈◊ËÕπ¢Õß°√–¥Ÿ° —πÀ≈—ß Imaging modalities ∑’Ë„™â¡’ 1. ®‘√æ√ ‡À≈à“∏√√¡∑—»πå ‡√’¬∫‡√’¬ß 18 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ . Plain films ‡ªìπ modality À≈—°·≈– “¡“√∂∑”„πÀâÕß©ÿ°‡©‘π‰¥â ∑à“∑’Ë ”§—≠∑’Ë ÿ¥∑à“·√°§◊Õ cross table lateral C-spine ‡æ◊ËÕµ√«®¥Ÿ alignment ¢Õß C-spine. etc. ‡Õ°´‡√¬å§Õ¡æ‘«‡µÕ√å∂◊Õ‡ªìπ modality ∑’˵âÕß„™â∂â“ plain film ¡’ªí≠À“∑“߇∑§π‘§À√◊Õ‰¡à Õ∏‘∫“¬Õ“°“√¢ÕߺŸâªÉ«¬ °“√∑” study µâÕß∑”‚¥¬„™â standard algorithm ·≈–µ“¡¥â«¬ retrospective reconstruction ‡ªìπ bone algorithm ®“°π—Èπ∑” retrospective reconstruction „π planes µà“ßÊ ‡™àπ sagittal. coronal. both oblique views ·≈– open mouth view ´÷Ë߇ªìπ∑à“  ”À√—∫¥Ÿ C2 / base of dens (∞“π¢Õß dens) ·≈–§«“¡ —¡æ—π∏å¢Õß C1-C2 °“√®—¥∑à“ºŸâªÉ«¬·≈–√Ÿª normal plain film anatomy ¢Õß°√–¥Ÿ° —πÀ≈—ß à«π§Õ· ¥ß„π√Ÿª∑’Ë 5 ∂÷ß√Ÿª∑’Ë 21 2. 3D. MRI „™âπâÕ¬¡“°‡æ√“–„Àâ√“¬≈–‡Õ’¬¥°√–¥Ÿ°‰¡à¥’æÕ ·≈–„™â‡«≈“∑”π“π ¡’§«“¡®”°—¥¡“°„π °“√π”«— ¥ÿÕÿª°√≥å„π°“√ immobilize ºŸâªÉ«¬ ·≈–°“√¥Ÿ·≈ºŸâªÉ«¬‡¢â“„πÀâÕß MRI „™â‡ªìπÀ≈—°„π°√≥’ ß —¬«à“ ¡’Õ—πµ√“¬µàÕ‰¢ —πÀ≈—ß (cord injury) ·≈–„™â„π°“√ follow up myelomalacia À√◊ÕºŸâªÉ«¬∑’Ë¡’ progressing symptom ¢Õß cord À≈—ßÕ“°“√ stable ¡“√–¬–Àπ÷Ëß·≈â« À≈—°°“√¥Ÿ plain film ¢ÕߺŸâªÉ«¬∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ„ÀâÕ“»—¬ çABCSé checklist ∑’Ë· ¥ß‰«â „πµ“√“ß∑’Ë 2 ‡æ◊Ëՙ૬„Àâ°“√∑” imaging study ·≈–¥Ÿøî≈塧√Õ∫§≈ÿ¡‰¥â§√∫∂â«π * √». 3. oblique.

4 transverse process 3. BDI √Ÿª∑’Ë 18 1.2 pedicles 3.4 §ÿ≥¿“æ¢Õßøî≈塵âÕߥ’‡ÀÁπ°√–¥Ÿ°™—¥‡®π 2. Bones 3. 20. 7.4 tip of spinous process 3.1 anteroir spinal line the 4 parallel lines 2.2 µâÕ߇ÀÁπ C1-C7 bodies.2 > 5 mm in children º‘¥ª°µ‘ interval) 1. 5 mm) 2.5 spinous process ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 19 .1 > 3 mm in adult º‘¥ª°µ‘ (anterior atlantodental 3. Alignment 2.1 vertebral bodies √Ÿª∑’Ë 10.3 lamina 3.3 spinolaminar line 2. AADI √Ÿª∑’Ë 17 3. Adequacy 1.5 mm) (basion-dental interval) 1.2 ‡¥Á° > 12 mm º‘¥ª°µ‘ (ª°µ‘ 2-11 mm/ avg.µ“√“ß∑’Ë 2 çABCSé checklist for the cervical spine trauma patients çABCSé checklist for the cervical spine trauma patients Normal Abnormal 1.2 posterior spinal line √Ÿª∑’Ë 16 2. 11.1 §√Õ∫§≈ÿ¡®“° foramen magnum ∂÷ß T1 √Ÿª∑’Ë 10. 14.1 ºŸâ„À≠à > 15 mm º‘¥ª°µ‘ (ª°µ‘ 2-15 mm/ avg.11 1. Base of the Dens ¥Ÿ®“°¿“æ lateral C1-2 and open mouth √Ÿª∑’Ë 7.3 µâÕ߇ªìπ¿“æ true lateral ·≈– AP 1. transverse ·≈– spinous processes 1. 21 3. 15 3.

æ.2 MRI 3.3 airways 3. Soft tissue 1. »Ÿπ¬å‰Õ·¡§ √. Scan the periphery 2.3 CTA/ MRA/ angiogram (Coutersy æ≠. 14. 19 1. Special examinations 3.2 ribs 2.2 paravertebral soft tissue 2. Cartilages 1.1 CT 3.2 facets 2. 15 1. 15 2.√“¡“∏‘∫¥’) À¡“¬‡Àµÿ ABCS checklist π’È¡’ª√–‚¬™πå™à«¬„Àâ°“√Õà“πøî≈塉¥â§√∫∂â«π ∂â“À“°∑”‰¡à‰¥â∑ÿ°¢âÕ  “¡“√∂𔉪ª√—∫„À¡à„Àâ‡À¡“– ¡ ”À√—∫·µà≈– ∂“∫—π 20 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ .µ“√“ß∑’Ë 2 çABCSé checklist for the cervical spine trauma patients (µàÕ) çABCSé checklist for the cervical spine trauma patients Normal Abnormal 1.1 prevertebral soft tissue √Ÿª∑’Ë 11.1 transverse ligament √Ÿª∑’Ë 10.2 interspinous ligament 1.«‘∫Ÿ≈¬å  ÿ√‘¬®—°√¬ÿ∑∏π“.1 clavicles √Ÿª∑’Ë 11. 17 2.1 intervertebral discs √Ÿª∑’Ë 10. Connective tissues 2. 14.

center ray ª√–¡“≥ C4 level √Ÿª∑’Ë 5 °“√®—¥∑à“ cross table lateral .„™â√–¬– FFD 40 π‘È« .«“ßøî≈å¡¢â“ß≈”§ÕºŸâªÉ«¬ ‚¥¬„™â∂—ßπÈ”‡ªìπÕÿª°√≥å™à«¬æ¬ÿß .®—¥ x-ray tube „Àâ‡Õ’¬ß‰ª∑“ß»’√…– 15-20 Õß»“ √–¬– FFD 40 π‘È« .center ray ª√–¡“≥ C4 level À√◊Õ Thyroid cartilage √Ÿª∑’Ë 6 °“√®—¥∑à“ AP ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 21 .®—¥∑à“ AP „À⺟âªÉ«¬πÕπÀß“¬∫π‡µ’¬ß «“ß·¢π·π∫¢â“ß≈”µ—« .®—¥∑à“ cross table lateral „À⺟âªÉ«¬πÕπÀß“¬∫π‡µ’¬ß«“ß·¢π·π∫¢â“ß≈”µ—« Àπÿπ »’√…–·≈–≈”§ÕºŸâªÉ«¬¥â«¬øÕßπÈ”‡æ◊ËÕ„Àâ√–¥—∫¢Õß°√–¥Ÿ°§ÕÕ¬Ÿà∫πøî≈å¡ ..

.«“ßøî≈å¡¢â“ß≈”§ÕºŸâªÉ«¬ ‚¥¬„™â∂—ßπÈ”‡ªìπÕÿª°√≥å™à«¬æ¬ÿß .„™â√–¬– FFD 40 π‘È« .center ray ª√–¡“≥ C7-T1 √Ÿª∑’Ë 8 °“√®—¥∑à“ swimmerûs view 22 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ .°“√®—¥∑à“ swimmerûs view „À⺟âªÉ«¬πÕπÀß“¬∫π‡µ’¬ß«“ß·¢π´â“¬·π∫¢â“ß≈”µ—«æ√âÕ¡‡Õ’¬ß ‰À≈à≈ß ™Ÿ·¢π¢«“¢÷Èπ .®—¥ x-ray tube „Àâ‡Õ’¬ß‰ª∑“߇∑⓪√–¡“≥ 3-5 Õß»“ √–¬– FFD 40 π‘È« .®—¥∑à“ open mouth view „À⺟âªÉ«¬πÕπÀß“¬ ∫π‡µ’¬ß«“ß·¢π·π∫¢â“ß≈”µ—« „À⺪⟠«É ¬Õ⓪“° „Àâ°«â“ß∑’Ë ÿ¥∑’Ë∑”‰¥â .center ray °÷Ëß°≈“ߪ“° ª√–¡“≥ C2 level √Ÿª∑’Ë 7 °“√®—¥∑à“ open mouth view .

®—¥ x-ray tube „Àâ‡Õ’¬ß∑”¡ÿ¡ 45 Õß»“„π·π« latero-medial ·≈–‡Õ’¬ß¡ÿ¡‰ª∑“ߥâ“π»’√…– 15-20 Õß»“ √–¬– FFD 40 π‘È« .°“√®—¥∑à“ lateral oblique .center ray ª√–¡“≥ C4 level À√◊Õ Thyroid cartilage √Ÿª∑’Ë 9 °“√®—¥∑à“ Thyroid cartilage ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 23 .®—¥∑à“ AP „À⺟âªÉ«¬πÕπÀß“¬∫π‡µ’¬ß«“ß·¢π·π∫¢â“ß≈”µ—« .

Plain film : normal cervical spine anatomy Plain film: C-spines: Lateral √Ÿª∑’Ë 10 Normal lateral view Plain film: C-spines: AP √Ÿª∑’Ë 11 Normal AP view 24 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ .

Plain Film C1-2 √Ÿª∑’Ë 12 Open mouth view for C1-2 and base of dens Swimmerûs view √Ÿª∑’Ë 13 °√≥’∑’Ë plain x-ray ‰¡à‡ÀÁπ C7-T1 „Àâ∑” Swimmerûs view to demonstrate the lower cervical spines ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 25 .

Plain film C-spines: Oblique √Ÿª∑’Ë 14 Left oblique for right neural foramen Plain film C-spines: Oblique √Ÿª∑’Ë 15 Right oblique for left neural 26 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ .

Normal cervical spine alignment and measurements The 4 parallel lines √Ÿª∑’Ë 16 The normal cervical alignment Atlantodental interval (ADI) ▼ ë adults >3 mm is abnormal ë children >5 mm is abnormal ë Maximum distance between dens and posterior arch of C1 in a child is 5 mm. This remains until both transverse and alar ligaments are torn. √Ÿª∑’Ë 17 Normal atlantodental measurement ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 27 .

5 mm) A ⁄B √Ÿª∑’Ë 18 The normal dens-basion measurement Prevertebral STS* 10 mm in front of ant arch of C1 6 mm in front of lower border of C2 24 4 mm in front of lower border of C3 25 22 mm in front of C6 24 * a crying child can have dramatic STS on lateral C-spine x-ray which mimics an injury * retropharyngeal infection can also mimic À√◊Õ„™âª√–¡“≥§√à“«Ê ‚¥¬Õ“»—¬ AP diameter ¢Õß C4 ‡ªìπÀ≈—° À¡“¬‡Àµÿ „π∑à“ flexion. avg.5 mm. uncorrected for magnification) ë children >12 mm is abnormal (range 211 mm.Instability Wholey Dens-Basion Line ë middle of upper end of odontoid process (B) lies directly beneath basion (A) ë adults >15 mm distance between basion and dens tip is abnormal (range 2-15 mm. avg. prevertrbral soft tissue ®–Àπ“°«à“ ª°µ‘¡“° °“√®—¥∑à“®÷ß¡’§«“¡ ”§—≠¡“° °≈à“«§◊Õ §ÕµâÕßµ√ß »’√…–‰¡à°â¡ √Ÿª∑’Ë 19 The normal value of prevertebral soft tissue shadow 28 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ . 7.

Dens equidistant from lateral mass on either side Distance between lateral mass of C1 and the dens related to neck rotation √Ÿª∑’Ë 20 The normal C1-2 relation Alignment of bodies of C1 and C2 Articular surface between C1 and C2 parallel √Ÿª∑’Ë 21 The normal C1-2 relation ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 29 .

¡.) 30 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ .¡. «— ¥ √–¬–√–À«à “ ß basion ·≈– tip of odontoid process ‰¥â 13 ¡. ≈Ÿ°»√∫π§◊Õ basion (anterior border of foramen magnum) 3.¡. ≈Ÿ°»√≈à“ߧ◊Õ tip of odontoid process 4. ‡ âπµ√ߧ◊Õ·π«¢Õß°√–¥Ÿ° clivus 2. ∂◊Õ«à“ º‘¥ª°µ‘ (§à“ª°µ‘„π‡¥Á° = 2-11 ¡. „π‡¥Á°‰¡à‡°‘π 12 ¡. ºŸâªÉ«¬‡¥Á° √“¬π’È¡’°“√‡§≈◊ËÕπ¢Õß°–‚À≈°‰ª∑“ß ¥â“πÀ≈—ß 1.Plain x-ray ∑’˺‘¥ª°µ‘ ·æ∑¬å∑’ˉ¡à„™àºŸâ‡™’ˬ«™“≠Õ“®¡’ªí≠À“„π°“√Õà“π plain x-ray ®÷߉¥â· ¥ß plain x-ray ∑’˺‘¥ª°µ‘∑’Ëæ∫ ∫àÕ¬ Õà“𬓰 ·≈–¡’ ‚Õ°“ º‘¥æ≈“¥ ‰«â¥—ßπ’È Atlanto-occipital dislocation °“√‡§≈◊ËÕπ¢Õß°–‚À≈°»’√…–Õ“®‡§≈◊ËÕπ‰ª∑“ߢâ“ßÀπâ“ (anterior) À√◊Õ¢÷Èπ∫π (upward) À√◊Õ‡§≈◊ËÕ𠉪∑“ߢâ“ßÀ≈—ß (posterior) µ“¡∑‘»∑“ߢÕß≈Ÿ°»√ ¥—ß„π√Ÿª °“√«—¥«à“¡’ dislocation À√◊Õ‰¡à „Àâ«—¥®“° skull base ¡“∑’Ë tip ¢Õß odontoid process §à“ª°µ‘„πºŸâ„À≠à‰¡à‡°‘π 15 ¡.¡.

¡. „Àâ ß —¬«à“¡’ Jefferson fracture √à«¡°—∫ rupture of transverse ligament ( à«π „À≠à®–¡’ C1-C2 instability) Hangmanûs fracture Hangmanûs fracture À¡“¬∂÷ß ¡’ fracture ¢Õß pedicle (pars interarticularis) ¢Õß C2 Hangmanûs fracture ▼ ▼ ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 31 .Jefferson fracture (C1 fracture) Õ“®®–‰¡à “¡“√∂«‘π‘®©—¬‰¥â®“° lateral plain x-ray C-spine  à«π„À≠à«‘π‘®©—¬‰¥â¥â«¬ open mouth view x-ray º≈√«¡¢Õߧ«“¡‡À≈◊ËÕ¡√–À«à“ߢÕ∫¢Õß C1 °—∫ C2 (Lateral mass) ∑—Èߥâ“π´â“¬·≈–¢«“ (µ“¡≈Ÿ°»√) ¡’§à“¡“°°«à“ 7 ¡.

¡.Dens fracture Dens fracture À√◊Õ fracture ¢Õß odontoid process ¢Õß C2 Õ“®®–‰¡à “¡“√∂«‘π‘®©—¬‰¥â®“° lateral plain x-ray C-spine  à«π„À≠à«‘π‘®©—¬‰¥â¥â«¬ open mouth view x-ray Atlanto-axial dislocation √–¬–Àà“ß√–À«à“ߢÕ∫À≈—ߢÕß anterior arch ¢Õß C1 ·≈–¢Õ∫Àπâ“¢Õß dens ¢Õß C2 ¡“°°«à“ 3 ¡. „π‡¥Á° ∂◊Õ«à“º‘¥ª°µ‘ 32 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ .¡. „πºŸâ„À≠à ·≈– 5 ¡.

Fracture C7 °“√∂à“¬¿“æ x-ray lateral C-spine µâÕß„Àâ‡ÀÁπ C7-T1 ¡‘©–π—ÈπÕ“®®–«‘π‘®©—¬ º‘¥æ≈“¥‰¥â ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 33 .

®Õ¡∑Õß √.∏√√¡»“ µ√凩≈‘¡æ√–‡°’¬√µ‘ √. 3. 6.ª“°‡°√Á¥ √.æ.‰∑√‚¬§ √.∏ß™—¬ ‡≈“À‰∑¬¡ß§≈ πæ. 17.‰«¿æ ‚æ∏‘«ß»å ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ §≥–·æ∑¬»“ µ√廑√‘√“™æ¬“∫“≈ §≥–·æ∑¬»“ µ√廑√‘√“™æ¬“∫“≈ «™‘√欓∫“≈ √.æ.æ. 7.Õ√√∂°√ °“≠®πæ‘∫Ÿ≈«ß»å πæ.Õ√™ÿ¡“ ¬—ß°‘®®“ πæ. 25. 9.∫àÕ‡°≈◊Õ √.‡æ‘Ë¡≈“¿ æß…åª√–¿“æ√√≥ æ≠.æ. √√§∫ÿ√’ √.æ. 5.æ.¥«ßæ√ ª√–¿“¡≥±≈ πæ.Õ—§§æß…å 𑵑 ‘ßÀå πæ. 24. ÿ√®‘µ ®‘πµ°“ππ∑å πæ. 13.æ.æ.·¡àÕ“¬ √. 19.æ. 12.µ√“¥ √.æß…å»—°¥‘Ï æ“π‘™æß…åæ—π∏ÿå æ≠.πæ. 16.™“≠≥√ߧå ∫ÿ≠»√’√—¡¬å πæ.æ.π§√ª∞¡ √.‡¢“§‘™¨°ŸÆ √.®µÿæ√ ‚™µ‘°«≥‘™¬å πæ.æ.‡®√‘≠°√ÿߪ√–™“√—°…å √.¬ß¬ÿ∑∏ »‘√‘ª√“°“√ πæ. 11. “√‘®πå »√’ ÿ¿“æ æ≠.°”·æ߇æ™√ √. 20. 10.‡¥àπ™—¬ ‰À≈«—≤π“ πæ.æ.æ.πæªÆ≈ §ŸÀ“ «— ¥‘Ï πæ.æ√–ª°‡°≈â“ √.æ. ¡‡¥Á®æ√–ªî¬¡À“√“™√¡≥’¬‡¢µ √.∫ÿ√’√—¡¬å √.¡–°“√—°…å √.¡ÿ®≈‘π∑å ‡©≈‘¡æ√æß»å πæ.æ.æ. 8.™“§√‘µ ªî≈—π∏π“°√ πæ.√“¬™◊ËÕºŸâ‡¢â“√à«¡ª√–™ÿ¡/ —¡¡π“ °“√ª√—∫ª√ÿß·π«∑“ß°“√√—°…“°“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ (Clinical practice guidelines for cervical spine injury) «—π∑’Ë 15 -16  ‘ßÀ“§¡ 2548 ≥ ÀâÕß¿“≥ÿ√—ß…’ ‚√ß·√¡√Õ¬—≈√‘‡«Õ√å ‡¢µ∫“ßæ≈—¥ °√ÿ߇∑æ¡À“π§√ 1. 4.æ.∫â“π‡¢«â“ √. 18.¡“π– Œ—πµ√–°Ÿ≈ πæ.ªí≠≠“ °≈àÕ¡ƒ∑—¬ πæ.∫“ß –æ“ππâÕ¬ ®—ßÀ«—¥°√ÿ߇∑æœ ®—ßÀ«—¥°√ÿ߇∑æœ ®—ßÀ«—¥°√ÿ߇∑æœ ®—ßÀ«—¥°√ÿ߇∑æœ ®—ßÀ«—¥°”·æ߇æ™√ ®—ßÀ«—¥°“≠®π∫ÿ√’ ®—ßÀ«—¥°“≠®π∫ÿ√’ ®—ßÀ«—¥°“≠®π∫ÿ√’ ®—ßÀ«—¥®—π∑∫ÿ√’ ®—ßÀ«—¥®—π∑∫ÿ√’ ®—ßÀ«—¥™—¬¿Ÿ¡‘ ®—ßÀ«—¥™—¬π“∑ ®—ßÀ«—¥‡™’¬ß„À¡à ®—ßÀ«—¥‡™’¬ß„À¡à ®—ßÀ«—¥µ“° ®—ßÀ«—¥µ√“¥ ®—ßÀ«—¥π§√ª∞¡ ®—ßÀ«—¥π§√ª∞¡ ®—ßÀ«—¥π§√»√’∏√√¡√“™ ®—ßÀ«—¥ππ∑∫ÿ√’ ®—ßÀ«—¥πà“π ®—ßÀ«—¥∫ÿ√’√—¡¬å ®—ßÀ«—¥∫ÿ√’√—¡¬å ®—ßÀ«—¥ª∑ÿ¡∏“π’ ®—ßÀ«—¥ª√–®«∫§’√’¢—π∏å .æ.æ. ¡™—¬ µ—Èß∫”‡æÁ≠ ÿπ∑√ πæ.≥—∞∏√ ¥“√“æß»å ∂“æ√ πæ.π‘≈ÿ∫≈ µµ‘¬«ß»å °ÿ≈ πæ.∏√“«‘∑¬å Õÿªæß…å æ≠. 2.æ.π§√ª∞¡ √.∑à“ Õ߬“ß √. 15.æ. 14.®√‘¬“ ®‘√“πÿ°Ÿ≈ πæ.°‘µµ‘ µ—πµ‘«ß»å°“πµå πæ.π“ß√Õß √. 34 º».æ. 23. 22. 21.¡À“√“™π§√»√’∏√√¡√“™ √.

æ.æ.æ.°–‡ªÕ√å √. π¡ √.πæ. 42.æ.æ√–®Õ¡‡°≈â“ √.Õà“ß∑Õß √. 54.¥”√ß√—°…å ™Ÿ‰æ±Ÿ√¬å πæ. —πµ‘¿“æ ·´àÕ÷Íß πæ. 47.§≥‘π∑√å °’√µ‘æß»å‰æ∫Ÿ≈¬å πæ. “¡√âÕ¬¬Õ¥ √.«‘¬–πÿ™ ‚≈¡–√—µπå πæ. 49.¥ßÀ≈«ß √.æ.æ.µ“≈ ÿ¡ √.æ. 45.°—≥‚™µ‘ ™“≠«π‘™¬å°ÿ≈™—¬ πæ. 34.æ.æ. 40. ß¢≈“π§√‘π∑√å √.æ. —πµ‘ Õ—ß§≥“‚ ¿‘µ πæ. 36. 53.æ.°—π∑√“√¡¬å √.¿—∑√‡°’¬√µ‘ Õ¡√«‘«—≤π°ÿ≈ πæ. 30.∫“߉∑√ √.ª≥µ ‡≈◊ËÕ¡ ”√“≠ √. 50.æ.Õÿµ√¥‘µ∂å √. 46.¡’™—¬ ™—¬√ÿàß‚√®πåªí≠≠“ πæ. ¡™“¬ ‡∑懮√‘≠π‘√—π¥√å πæ.æ. √√æ ‘∑∏‘ª√– ß§å √.√“™∫ÿ√’ √.∏’√«ÿ≤‘ æÿ∑∏√—°¢‘µ πæ.∏’√–»—°¥‘Ï «‘√‘¬“ππ∑å æ≠.æ.‡∑«‘π∑√å ™«π–ª√“≥’ πæ.∫â“π≈“¥ √.æ√–æÿ∑∏™‘π√“™ √.æ.«—≤π“  ÿ¢Õ«¬™—¬ πæ. 55.æ√À¡∫ÿ√’ √.≥—∞ À“«“√’ πæ. 33.æ.æ.ÀπÕߧ“¬ √.§à“¬∫“ß√–®—π √.26.æ. ß«π ‘π √—µπ‡≈‘» πæ.π¿— °√≥å ‚°¡“√∑—µ πæ. πæ.°‘µµ‘™—¬ ªí°∏߉™¬ πæ.Õ√—≠ª√–‡∑» √.≥¬» ª≥‘∏“π∏√√¡ πæ.°ƒµ∏’ ‚§≈–∑—µ πæ.æ.‡™’¬ß¡à«π √. ÿ¥‡¢µ π√—∞°‘® πæ.æ. 41.≥√ߧ噗¬ ™Õ∫ª√–¥‘∂ πæ. 48. ¡ÿ∑√ª√“°“√ √. 52.™—¬«—≤πå Õ“™«°ÿ≈‡∑æ ».‡ π“ß§π‘§¡ ®—ßÀ«—¥ª√–®«∫§’√’¢—π∏å ®—ßÀ«—¥ª√“®’π∫ÿ√’ ®—ßÀ«—¥æ√–π§√»√’Õ¬ÿ∏¬“ ®—ßÀ«—¥æ—ßß“ ®—ßÀ«—¥‡æ™√∫ÿ√’ ®—ßÀ«—¥‡æ™√∫ÿ√’ ®—ßÀ«—¥æ–‡¬“ ®—ßÀ«—¥æ–‡¬“ ®—ßÀ«—¥æ‘…≥ÿ‚≈° ®—ßÀ«—¥¡ÿ°¥“À“√ ®—ßÀ«—¥√“™∫ÿ√’ ®—ßÀ«—¥√“™∫ÿ√’ ®—ßÀ«—¥√–πÕß ®—ßÀ«—¥ ß¢≈“ ®—ßÀ«—¥ ¡ÿ∑√ª√“°“√ ®—ßÀ«—¥ ¡ÿ∑√ª√“°“√ ®—ßÀ«—¥ ¡ÿ∑√ ß§√“¡ ®—ßÀ«—¥ √–∫ÿ√’ ®—ßÀ«—¥ √–∫ÿ√’ ®—ßÀ«—¥ ‘ßÀå∫√ÿ ’ ®—ßÀ«—¥ ‘ßÀå∫ÿ√’ ®—ßÀ«—¥ ÿ√‘π∑√å ®—ßÀ«—¥ ÿ√“…Æ√å∏“π’ ®—ßÀ«—¥»√’ –‡°… ®—ßÀ«—¥ÀπÕߧ“¬ ®—ßÀ«—¥ÀπÕß∫—«≈”¿Ÿ ®—ßÀ«—¥Õÿµ√¥‘µ∂å ®—ßÀ«—¥Õÿ∫≈√“™∏“π’ ®—ßÀ«—¥Õÿ∫≈√“™∏“π’ ®—ßÀ«—¥Õà“ß∑Õß ®—ßÀ«—¥Õ”𓮇®√‘≠ ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 35 .æ. 28.À√√…“ ·µâ»‘√‘ πæ.™—™™—¬ ‡≈Á°æ‘∑¬“ πæ.π“°≈“ß √. 56.æ. 29.π¿“≈—¬ √.æ. 27. 31.æ–‡¬“ √.‰°√ ‘∑∏‘Ï ‰µ√√—µπ“√—»¡’ πæ.æ. 32.™—¬ Õ√‘¬»√’«—≤π“ πæ.æ.‡°“– ¡ÿ¬ √. 43. 38.æ.ÀπÕß·§ √. 35.æ. 39.æ.æ√–π§√»√’Õ¬ÿ∏¬“ √.æ. 44. 37.™—¬æ√ °“√–‡°µÿ πæ.æ.«√™—¬ Õ÷ÈßÕ¿‘π—π∑å πæ.ª“°∑àÕ √.®√—≥∏√  ÿ¢„¬ πæ. 51.ÀπÕß‚¥π √.æ.∫“ß®“° √.π‘ ‘µ »√’ ¡∫Ÿ√≥å æ≠.

36 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ .

·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ 37 .

38 ·π«∑“ß°“√√—°…“ °“√∫“¥‡®Á∫°√–¥Ÿ° —πÀ≈—ß à«π§Õ .