外科学脊柱骨折与脊髓损伤(英文)

Spine Fracture and Spinal Cord Injuries,Introduction,Incidence ：5%6% in all bone fractures Etiology Falling Hit Traffic accident Supplement : normal adult ; primary injuries,Thoracic and lumbar spinal fracture and dislocation,Part 1:,Anatomy,Ligament and disc,Three column theory,A,M,P,Clinical classification,according to Injury mechanism -Flexion-distraction common 80-90% -Extension-distraction rare -Rotation -Compression (flexion or vertical ),Radiology of spinal fractures,Vertical compression,Radiology of spinal fractures,Flexion compression,Which type of fracture is?,Chance Fracture,Distraction Fracture,Cervical spine fracture and dislocation,Part II:,1. Bifid spinous process of C3 2. Superimposed articular processes 3. Uncinate processes 4. Air filled trachea 5. Transverse process of C7 6. Transverse process of T1 7. 1st rib 8. Clavicle,Radiological anatomy,1. Anterior arch of the atlas 2. Dens of axis 3. Posterior arch of the atlas 4. Soft palate 5. Root of the tongue 6. Transverse process 7. Intervertebral disc 8. Inferior articular process 9. Superior articular process 10. Zygapophyseal (facet) joint 11. Spinous process of C7 2nd-7th: The bodies of 2nd to 7th cervical vertebrae,Anatomy of C1-C2,Classification,1 Upper cervical spinal fracture-dislocation(C1-C2,2 Lower cervical spinal fracture-dislocation (C3C7),Atlas(C1) vertebral fracture,Jefferson fracture,Atlantoaxial dislocation,Axial(C2) vertebral Fr.,Hangman fracture,Odontoid fracture,Lower cervical fracture-dislocation,Compression-flexion fr Dislocation of the facets Cervical extension injuries,Bilateral dislocation,Unilateral dislocation,Spinous process fracture(C7,T1,T2,Distraction-extension Fr,Stability of the fracture,Stable spinal injury: Movement of the patient causes minimal or no risk of producing or aggravating neural injury.(usually 1 column involved) Unstable spinal injury: Spinal canal is unable to maintain normal relationships under physiologic conditions usually 2 or 3 columns involved),3-column broken,Chance fracture,Clinical manifestations,Case history： history of injuries: complains pain，swelling，disturbance of body or joint activity spinal cord injury(SCI)： - clinical features of neurologic deficit: ， Combining injuries,Diagnosis,History Clinical manifestations and physical examination Imaging Technology - X-ray - CT scan - MRI,First aid,First aid to SCI Correct transfer Temporary fixation（neck brace or lumbar corset）,treatment,Cervical fracture -non-displacement and stable fr.：neck brace，plaster immobilization -displacement and instable fr. : traction + plaster temporary traction + surgical therapy -Fracture with SCI: surgical decompression and fusion,TREATMENT GOAL,Include protecting nerve function and restoring alignment and stability of the spine,Nonsurgical Treatment,compression fractures and some burst fractures without surgery. With a simple compression fracture, to wear a hyperextension brace for sitting and standing activities for 6 to 12 weeks. Patients should walk and do other exercises while healing and may take medications for pain. With a transverse process fracture, patients may need to wear a thoracolumbar corset and participate in an aerobic walking program.,Surgical Treatment,Some spine fractures require surgical treatment. Steroids may be prescribed if the spinal cord is also injured. Surgery may be necessary for unstable burst fractures, flexion-distraction injuries, or fracture-dislocation injuries. Surgery realigns the spinal column and holds it together using metal plates and screws (internal fixation) and/or spinal fusion.,Spinal cord injuries(SCI),Anatomy of spinal cord,Causes,Destruction from direct trauma Compression by bone fragments, hematoma, or disk material Ischemia from damage or impingement on the spinal arteries,Spinal cord injuries (SCI),Pathological change Spinal cord concussion：short-term，recoverable Spinal cord contusion：spinal cord degeneration，necrosis，hardly reversible, completely,or incompletely,classification,Concussion of the spinal cord Spinal cord shock Incomplete spinal cord injury Complete spinal cord injury Conus medullaris syndrome,classification,Tetraplegia (replaces the term quadriplegia) - Injury to the spinal cord in the cervical region, with associated loss of muscle strength in all 4 extremities Paraplegia - Injury in the spinal cord in the thoracic, lumbar, or sacral segments, including the cauda equina and conus medullaris,Identification of complete and incomplete paraplegia,sacral-sparing,Perform a rectal examination to check motor function or sensation at the anal mucocutaneous junction. The presence of either is considered sacral-sparing. Definitions of complete and incomplete SCI are based on the above ASIA definition with sacral-sparing. Complete - Absence of sensory and motor functions in the lowest sacral segments Incomplete - Preservation of sensory or motor function below the level of injury, including the lowes