Unilateral facet joint dislocation
Introduction
Introduction to unilateral facet joint dislocation Unilateral facet joint dislocation is a relatively common injury, usually caused by the synergy of flexion and rotational violence. Mainly manifested as local symptoms of the neck and the symptoms of the corresponding spinal segment injury when combined with nerve injury. In addition to pain, compulsive head and neck tilt, deformity of cervical spine extension and limited rotational function, the most common complications are spinal cord and nerve root injury. Spinal cord injury can occur simultaneously during articular process and dislocation. It can also be a postoperative complication due to inadvertent injury during treatment. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific people Mode of infection: non-infectious Complications: spinal cord injury
Cause
Causes of unilateral facet joint dislocation
Pathogenesis:
Similar to the flexion injury, when the head and neck are subjected to flexion and impact, the neck not only flexes, but also has a motion of rotating to one side. When the buckling and rotating external force simultaneously act on the cervical vertebra, the damaged segment is formed to be twisted forward and downward. Violence, with the posterior central part of the intervertebral disc as the axis, the upper cervical subarachnoid on one side rotates backward, while the other lower articular process slides forward and exceeds the superior articular process of the lower vertebral body to the front, forming a "crossing" The state of the lock, the upper and lower joints collide with each other, and can also cause joint fracture.
Pathological changes:
The joint capsule tear of the bilateral articular process, the anterior longitudinal ligament, the posterior longitudinal ligament, the intervertebral disc and the posterior ligament complex structure can be damaged. The dislocation of the joint is located in front of the superior articular process, the intervertebral foramen is deformed or narrowed, and the nerve The root is prone to damage. This dislocation is considered to be a relatively "stable" state of cervical spine injury, but the two articular surfaces of the non-dislocation side are separated from each other, and the intervertebral disc annulus is subjected to sustained rotational stress. This asymmetry dislocation The spinal canal is deformed and narrowed in the plane of injury, which can cause spinal cord injury.
Prevention
Unilateral facet joint dislocation prevention
Because this disease is usually caused by the synergy between flexion violence and rotational violence, it is the key to prevent this disease from paying attention to production and life safety and avoiding injury. At the same time, it is necessary to observe whether there is a combined injury of nerve and spinal cord to avoid missed diagnosis.
Complication
Complications of unilateral facet joint dislocation Complications spinal cord injury
In addition to pain, obsessive head and neck tilt deformity, cervical spine extension and rotational function limitation, the most common complications are spinal cord and nerve root injury embolism. Spinal cord injury can occur simultaneously during articular process and dislocation. It may also be a postoperative complication due to inadvertent injury during treatment.
Symptom
Symptoms of unilateral facet joint dislocation Common symptoms Allergic neck is afraid of flexion, fear of nerve root injury, limb extremity, compulsive head and neck tilt deformity
The clinical manifestations of this disease mainly have the following two aspects:
1, the local symptoms of the neck are more prominent, pain, obsessive head and neck tilt deformity, cervical spine extension and rotation function is limited.
2, combined with spinal cord and nerve root injury manifested as the symptoms of the corresponding spinal segment: quadriplegia, lower extremity spasm or partial spasm, nerve root injury, manifested in the nerve distribution area skin hypersensitivity, pain or sensation.
Examine
Examination of unilateral facet joint dislocation
The auxiliary examination method for this disease is mainly X-ray examination.
The characteristic manifestation of X-ray is the key to diagnosis. The typical sign of lateral X-ray film is: the displacement of the dislocated vertebral body is 1/3 of the posterior diameter of the vertebral body, at most 1/2, at On the plane of the dislocated vertebral body, the relationship between the normal facet joints cannot be seen (below)
Schematic diagram of X-ray film of unilateral facet joint dislocation
The spinous processes located at the front and rear of the cervical vertebrae are offset from the center and are offset from the side of the facet joint. The oblique slice can clearly show the dislocation of the facet joint or the "interlocking" sign.
Diagnosis
Diagnosis and diagnosis of unilateral facet joint dislocation
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Unilateral facet joint dislocation should be differentiated from bilateral articular dislocation. According to the injury and clinical manifestations, the following aspects can be identified:
1, the injury mechanism of different bilateral anterior dislocation of the small joints with flexion violence, and unilateral facet joint dislocation in addition to flexion violence also there is a reversal of violence.
2, clinical manifestations of bilateral bilateral facet joint dislocation mainly manifested as anterior tilt fixation, extensive tenderness; most with spinal cord injury, unilateral facet joint dislocation with rotation fixation, tenderness is not extensive, a small number of spinal cord injury, but local pain.
3, X-ray performance of the bilateral dislocation of the injured segment of the vertebral body forward movement distance is often 2 / 5 or 1/2 of the anterior and posterior position of the vertebral body, the lower cervical facet of the upper cervical vertebrae is located at the top of the lower cervical orbital process In the anterior direction, the anterior movement of the vertebral body in the unilateral facet joint dislocation is about 1/3 of the anteroposterior diameter, and the anterior segment can be seen in the dislocation of the spine.
