Spinal trauma

Introduction

Introduction to spinal trauma

Spinal trauma is caused by compression fractures, flexion or lateral flexion, the most common of which is the anterior wedge fracture with reduced vertebral height. In addition, there are lateral compression fractures, that is, the height of the sides of the vertebral body is different. These wedge changes are often accompanied by damage to the vertebral endplates and damage to the intervertebral disc, which can be pressed into the vertebral body. However, the height of the posterior margin of the vertebral body with compression fracture is unchanged, which is different from the burst fracture.

basic knowledge

The proportion of illness: 0.012%

Susceptible people: no special people

Mode of infection: non-infectious

Complications: fracture

Pathogen

Cause of spinal trauma

Cause:

Any violence that causes excessive flexion, overstretching, rotation, or lateral flexion of the spine can cause spinal damage. In normal times, most patients with spinal fractures and dislocations fall from high altitude, land on the feet or hips, and the weight of the upper body plus the impulse to make the spine excessively flexed; or the weight falling from the height falls on the patient's head or shoulders. It can also cause excessive flexion of the spine and cause fracture and dislocation of the spine. Some abnormal conditions, such as car accidents, landslides, earthquakes, explosions, diving and sports skills, are also common causes of spinal injuries.

Prevention

Spinal trauma prevention

First, you must observe the injury, you can't "sit on the beat"

People have a habit of finding someone falling to the ground and always wanting to lift it up. Especially for people who have lost their minds, they often take the form of sitting and patting calls to make them wake up. In fact, this is a very dangerous action. Before the injury is clear, it is absolutely impossible to tamper with the wounded. The first thing the rescuer needs to do is to observe the injury. If the injured person's head, chest, spine, pelvis and other important parts are damaged, they should not change their position.

Second, it is necessary to pull straight and not bend the " pocket"

Anyone suspected of having a head or neck spine injury should try to stay in place and wait for the ambulance personnel; when moving the wounded person, the spine should be pulled and straightened so that even if there is a vertebral fracture, the spinal cord in the spinal canal will not be contused. nerve. It is impossible to bend the spine and take a "squat pocket" type of handling method in which one person lifts the armpit and lifts the lower limb, causing the vertebral fracture fragments to stab the spinal nerve.

Three must turn over the coaxial, can not be rotated "twist twist"

Anyone who doubts the spinal injury must turn the head, neck, and torso of the lower torso coaxially and overturned when turning over, and must never turn over the twisted twist. This will twist or crush the spinal cord at the fracture site, causing or aggravating paraplegia. Therefore, when the wounded person turns over, at least three people should be forced up and down at the same time to keep their spine in the axial position and turn the position at the same speed.

Fourth, the hard board is fixed, do not canvas "soft stretcher"

Before transporting the injured, be sure to fix the injured person in situ. The injured person should be fixed on the hardwood stretcher. Never use the canvas soft stretcher to transport the injured.

Five must observe breathing, can not ignore "breathing paralysis"

Cervical trauma is most likely to cause high paraplegia with respiratory muscle paralysis (including thoracic muscles, diaphragm muscles) and affect breathing, and cervical spine fractures are most susceptible to secondary damage. Some of the wounded patients were originally simple cervical spine fractures. They could still breathe without spinal cord injury. However, accidentally injuring the cervical spinal cord during the rescue process may cause difficulty in breathing or stop. If assisted artificial respiration is performed before the heartbeat stops, it is still possible to sustain life. Therefore, in the neck trauma rescue, special attention should be paid to observing the victim's breathing to prevent respiratory arrest and life-threatening.

Six specialist treatments should not let the wounded "circle"

Suspected patients with spinal injuries must be sent directly to an orthopedic hospital (with spinal surgery is better), so that the examination diagnosis surgery rehabilitation treatment one-stop, do not switch between hospitals without bone specialist conditions Go and go, repeat the consultation.

Complication

Spinal trauma complications Complications

The vast majority of spinal fractures and dislocations occur in the range of motion and small mobility of the spine. Here, it is also the transition of the lordosis of the lordosis, such as the neck 1 to 2 and the neck 5 to 6. The fractures of the thoracic 11 to 12, the waist 1 to 2 and the waist 4 to 5 are the most common, accounting for more than 90% of the spinal fractures, while the fractures of the thoracolumbar (thorax 11 to the waist 1 and 2) account for the spine. 2/3 to 3/4 of the fracture.

Symptom

Symptoms of spinal trauma Common symptoms Osteoporosis Compression fracture Avulsion fracture Forced prone position paraplegia

The traditional classification is based on the external force of the injury, such as flexion, extension, rotation and longitudinal pressure damage. This traditional classification method is not ideal because an external force can produce more than one type of spinal injury, and the old classification does not help with treatment options. Canada Armstrong combines his own experience with the classification of some Western authors, suggesting that the spine fractures are classified into seven types according to the lesion morphology. Each type has its own unique damage characteristics and is associated with a specific treatment method. The new classification method makes the treatment of spinal fractures more scientific. The characteristics of each type are now described as follows.

(1) Compression fracture caused by flexion or lateral flexion, the most common is the anterior wedge fracture with reduced anterior height of the vertebral body. In addition, there are lateral compression fractures, that is, the height of the sides of the vertebral body is different. These wedge changes are often accompanied by damage to the vertebral endplates and damage to the intervertebral disc, which can be pressed into the vertebral body. However, the height of the posterior margin of the vertebral body with compression fracture is unchanged, which is different from the burst fracture.

(B) Rotational injury X-ray examination shows that one vertebral body rotates on the other vertebral body. Sometimes the intervertebral space is narrowed, mainly due to fibrous ring and nucleus pulposus injury. The upper edge of the leading edge of the next vertebral body can be torn off by a small piece of the annulus, but the height of the vertebral body does not change. A few have only a narrow intervertebral space and no avulsion of the annulus fibrosus.

(c) A burst fracture is a fracture caused by violence acting along the longitudinal axis of the body. The intervertebral disc is pressed into the vertebral endplate and injured into the cancellous bone. The vertebral body is split by a central "explosion", and the fracture piece is pushed to the square, and the posterior margin of the vertebral body is fractured, and the fracture piece protrudes into the spinal canal. The distance between the pedicles is split and widened. Often with the longitudinal laminar fracture of the posterior lamina, the greater the rupture of the anterior vertebral body, the more obvious the vertebral fracture. (Sometimes only the vertebral plate fractures can be found by CT scan. The burst fractures can be divided into five types:

1 At the same time, there are upper and lower endplate injuries, accompanied by vertebral body posterior margin fractures protruding into the spinal canal, compressing the spinal cord, and producing neurological symptoms.

2 The upper half of the vertebral body fracture, the posterior compression of the vertebral body, and the fracture piece rotates into the spinal canal. This type is most common.

3 lower vertebral endplate damage.

4 Explosive type combined with a rotational fracture, in addition to the characteristics of the burst type fracture, it can also be seen on the side of the spine.

5 Explosive fracture combined with lateral compression fracture, the fracture line obliquely through the vertebral body, the pedicle distance is widened, the height of the vertebral body is different, often accompanied by multiple transverse fractures, this type is the most unstable. The main features of the explosive fracture are: widening of the pedicle spacing, compression of the posterior part of the vertebral body, height reduction, and widening of the transverse diameter of the vertebral body. Almost all burst fractures have neurological symptoms.

(4) Shear fractures, also known as slice fractures. Often caused by flexion and rotation violence, all ligaments in front of and behind the spine are torn, may be associated with one or both sides of the small joints, transverse processes and pedicle fractures, but the vertebral bone destruction is not obvious, the height of the vertebral body is unchanged . However, the rotating shear force can tear off the small bone of the next upper edge of the vertebral body, just like a knife cuts a thin piece. Since all structures are almost completely traversed, the fractures are highly unstable and patients often have complete paraplegia. X-ray films can be seen as "slice" shaped fractures and widening of intervertebral space.

(5) The posterior vertebral fracture is also called seat belt fracture. This fracture was first described by Chance in 1948, so the literature is often referred to as the Chance fracture, which is a flexion fracture. The typical damage mechanism is that the car seat belt is carried on the waist and abdomen of the patient. When the high-speed car suddenly decelerates or crashes, the trunk above the fulcrum bucks the buckling, and the frontal force also produces a forward transverse process, and then penetrates the pressure. Thread the rod and tighten the nut for pressure fixing. It should be particularly pointed out that for those with a posterior intervertebral space widening and avulsion fractures, it is indicated that there is disc injury, and sometimes the symptoms of the nervous system appear after being reset by Harrington compression. This is due to the fact that the injured intervertebral disc protrudes into the spinal canal during compression. For such fractures, the injured disc should be removed prior to compression reset.

Examine

Spinal trauma examination

There were 27 cases of dislocation fractures. The plain film showed spinal fracture with dislocation or subluxation. The vertebral body displacement on CT can be determined according to the "double loop" sign. CT can clearly show cervical uncinate process, vertebral facet joint fracture and dislocation. The relationship between the atlantoaxial joints can also be displayed, and whether the joint is dislocated or subluxated can also be clearly displayed. The three-column concept of the spine is suitable for CT examination. The anterior column includes the anterior longitudinal ligament, the anterior segment of the vertebral body and the anterior fiber annulus; the middle column is the posterior half of the vertebral body, the posterior fibrous annulus and the posterior longitudinal ligament; the posterior column is composed of the accessory bone structure, the small joint capsule, the ligamentum flavum, The interspinous ligament and the superior ligament of the spinous process.

Diagnosis

Diagnosis and diagnosis of spinal trauma

The spine is the central axis of the human body. The limbs and the skull are directly or indirectly attached to it. Therefore, the impact force or pressure on any part of the body may be transmitted to the spine and cause damage. This should be remembered when treating multiple patients with injuries to avoid missed diagnosis. The spine has four physiological curvatures. At the transition of the kyphosis of the spine, the force is greater, which is the most vulnerable part of the entire spine. There are 23 tough and elastic intervertebral discs between the vertebral bodies. When the spine is injured, depending on the direction of violence, the intervertebral disc can be pressed into the spinal canal under pressure, compressing the spinal cord, and can also be embedded in the cortex and cancellosis of the next vertebral body. Inside the bone, it even causes the vertebral body to split around and form a bursting fracture.

In the neck, the small joint space of the vertebral body is almost horizontal, so it is easy to dislocate forward or backward or left and right, and it is easy to be naturally reset after dislocation. Therefore, in clinical cases, cases of traumatic high paraplegia are often seen, and X-ray films show cervical vertebrae. The anatomy is normal. In the thoracic segment, the facet joint gap is almost perpendicular to the horizontal plane, so there is very little dislocation. At the waist, the arrangement of the facet joints is one inside and one outside, that is, the upper articular process is external and the lower articular process is included, so the lumbar spine is less prone to simple dislocation and interlocking unless there is a joint fracture of one side. The first cervical vertebrae, no vertebral body and spinous processes, the anterior and posterior sacral vertebrae are relatively thin, and the side blocks are particularly weak, so local fractures are prone to occur.