Cervical vertebral fracture and dislocation without spinal cord injury
Introduction
Introduction to cervical spine fracture and dislocation without spinal cord injury Each cervical vertebra is composed of two parts: the vertebral body and the vertebral arch. The vertebral body has an elliptical columnar body, and the vertebral body is connected with the vertebral body, which together form a vertebral foramen. All the vertebral holes are connected to form the spinal canal, which is accommodated in the spinal cord. The cervical vertebra is the smallest segment of the spine, but the segment with the highest flexibility, the highest frequency of activity, and a large load. Various violent effects cause cervical spine fracture and dislocation, usually combined with different degrees and types of spinal cord injury. However, some very severe fractures and dislocations are not accompanied by or have only minor spinal or nerve root damage. This particular type of injury is fortunate to the injured. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of infection: non-infectious Complications: muscle spasm cervical spine fracture and dislocation
Cause
Causes of cervical spine fracture and dislocation without spinal cord injury
The mechanism of cervical spine fracture and dislocation without spinal cord injury is complicated: hyperextension compression injury plays a vital role, especially when the injury occurs on the forehead and face. Some scholars believe that the overextension compression injury first caused a dislocation in the dislocation site. Shear force, causing rupture of the anterior longitudinal ligament, rupture of the endplate of the intervertebral disc, separation of the posterior longitudinal ligament from the posterior edge of the vertebral body, and its compressive force causes separation of the anterior, middle and posterior vertebral bodies, resulting in laminar fractures; It has been reported in the literature that laminar fracture is a relatively easy change in cervical hyperextension injury. The laminar fracture causes the anterior and middle column of the vertebral body to lose support and produce anterior dislocation. The degree of dislocation depends on the external force of the vertebral body. The degree of injury of the posterior longitudinal ligament and intervertebral disc, the degree of damage of the laminae fracture, and the laminar fracture reduce the damage of the posterior column ligament structure of the vertebral body. However, despite the anterior vertebral dislocation, the cervical facet joint and spinous process of the dislocated segment No displacement occurred. Therefore, the sagittal diameter of the spinal canal was not reduced at the dislocation, nor was the compression of the spinal cord, or only slight compression, so it was not easy to cause spinal cord injury.
When an external force acts on the posterior or posterior aspect of the neck to produce a flexion injury, the external force causes the neck to form a forward whiplash motion, and the instantaneous force destroys the tissue structure at the back of the neck, especially the ligament and joint. The destruction of the capsule structure partially loses the stability of the cervical vertebrae, so the dislocation occurs before the degree of dislocation depends on the size of the external force and the degree of destruction of the tissue structure. The consideration of the absence of spinal cord injury may be related to the following factors:
1 The patient's cervical spinal canal congenital sagittal diameter is wide, and the residual sagittal diameter of the cervical canal can still accommodate the spinal cord without damage.
2 The posterior longitudinal ligament (posterior longitudinal ligament, interspinous ligament, joint capsule ligament) has less structural damage, at least incomplete injury, which can still partially restrict the excessive anterior dislocation of the vertebral body to a certain extent, avoiding Causes spinal cord injury.
3 In the case of particularly severe external force, the damaged lamina will also be fractured. In this case, even if the vertebral body has obvious anterior dislocation, it will not reduce the sagittal diameter of the spinal canal and cause spinal cord injury. .
4 After the dislocation, the cervical vertebra showed a buckling change, the entire cervical vertebra was shortened in the longitudinal length, and the spinal cord also showed a distortion-like "accordion-like" change, avoiding the spinal cord compression caused by the change of the anatomical position of the bony structure.
Prevention
Prevention of cervical spine fracture and dislocation without spinal cord injury
Pay attention to the safety of production and life, and avoid trauma is the key to the prevention and treatment of this disease. In addition, early detection, early diagnosis and early treatment are the key to prevent further damage of this disease. For patients with less obvious symptoms of spinal cord injury, further use of auxiliary examination measures should be used for identification. Diagnosis, must not be easily concluded, prevent missed diagnosis, delay the treatment of patients.
Complication
Complications of cervical spine fracture and dislocation without spinal cord injury Complications, muscle spasm, cervical spine fracture and dislocation
Cervical fractures or fractures and dislocations are often accompanied by cervical spinal cord injury, leading to complete or incomplete paraplegia, but there are also some cervical fractures and dislocations in the clinic, and even some of the more serious cervical fractures and dislocations without cervical spinal cord injury, but only performance In order to stimulate or compress the nerve roots, these patients only show a reduction in the range of motion of the neck, and sometimes the rotation is limited, which is related to the pain of the injured segment and muscle spasm. The patient's own insecurity is also the cause of exercise limitation. One, but other complications are less common.
The disease is more common in some postoperative complications: if non-surgical treatment, such as skull traction, external plaster fixation and Halo stent, although it can play a certain role of reduction and fixation, there is a long treatment period. The curative effect is not true and it is difficult to restore or maintain the defects of cervical intervertebral height and physiological curvature, especially the injured intervertebral disc can not repair itself, resulting in the persistence of cervical instability, and the subsequent secondary spinal cord injury is inevitable.
Symptom
Cervical fracture and dislocation symptoms without spinal cord injury Common symptoms Cervical fracture and dislocation neck pain Spinal cord compression nerve root stimulation
The cervical spine injury without spinal cord compression, the feeling of limbs and trunk, the urinary defecation function of motor function are all normal or only nerve root stimulation symptoms, and the local symptoms of the injury site are the clinical manifestations of this type of injury.
1. Neck pain: The pain is mostly in the injured segment, but it also involves the entire neck and may have tenderness.
2. The cervical vertebrae showed a flexion deformity or a stiff shape: it showed a forced head and neck anteversion and a stiff deformity.
3. Limited movement: the range of neck movement is reduced, and sometimes the rotation is limited. This is related to the pain of the injured segment and muscle spasm. The patient's own insecurity is also one of the causes of exercise limitation.
4. Limbs: The limbs and trunk are normal, the movement is not limited, the tendon reflex is normal, and there is no pyramidal sign.
Examine
Examination of cervical spine fracture and dislocation without spinal cord injury
X-ray examination is the main basis for confirmation. The cervical vertebrae are routinely photographed to show whether the spinous processes are displaced laterally and the intervertebral joints are changed. The left and right oblique slices are used to understand the changes of intervertebral foramen and posterior structures. After the anterior and posterior position (should be taken under the supervision of a physician), the main performances are as follows:
1. The cervical vertebral body is dislocated forward and the bilateral facet joint dislocation.
2. One side of the small joint dislocated forward, the vertebral body dislocated to the lateral anterior, and the vertebral arch and facet joint fracture.
3. Anterior vertebral body dislocation combined with vertebral body leading edge fracture.
4. There is no fracture in the posterior cervical spine, and the spinous processes of the upper and lower spine of the dislocated spine are flat. The vertebral arch fractures are normally arranged in the lamina and spinous processes and the lower spine.
The tomographic and CT scans of the injured segment show subtle or concealed bone and joint injuries, and MRI imaging can show the relationship between spinal cord morphology and spinal canal.
Diagnosis
Diagnosis and differentiation of cervical spine fracture and dislocation without spinal cord injury
The disease needs to be differentiated from brain injury with cervical spine injury:
Clinically, no spinal cord injury type fracture and dislocation is not completely asymptomatic and physical signs. Careful examination can have the following manifestations: patients with mild head injury can self-report neck pain, and the curvature of the neck is changed or stiff. Restricted exercise, sometimes the neck may have congestion, swelling or accompanied by nerve root irritation, etc., can be used for reference, but in the case of severe craniocerebral injury with cervical spine injury, there is no combined cervical spinal cord injury in clinical It is difficult to distinguish, especially severe craniocerebral injury and neck injury in the symptoms and signs are concealed, so it depends on the different footprint of the brain and cervical spinal cord injury, MR I, autopsy and patient recovery period of the referral data for identification .
