lumbar fracture
Introduction
Introduction to lumbar fracture Because the thoracolumbar segment is located between the relatively fixed thoracic vertebrae and the highly active lumbar vertebrae, it is more susceptible to damage as a kinetic point of motion stress. Clinically, it accounts for more than 90% of all spinal fractures and dislocations, and more than 70% of them occur in the thoracic and lumbar segments (the 12th thoracic vertebrae and the 1st lumbar vertebrae are the most). In addition to bone structure damage, thoracolumbar fractures are often accompanied by spinal cord, cone, and horsetail injury, causing paraplegia and even death, and can seriously affect the anatomical and physiological changes of the internal organs. Compression fractures are mainly caused by the violent movement of the head and feet, which causes the spine to suddenly and excessively flex. Due to the flexion of the spine, the external force concentrates on the front of a vertebral body, and is also squeezed by the upper and lower vertebral bodies. Therefore, the vertebral body is compressed and wedge-shaped, and is displaced backward to damage the spinal cord or cauda equina. If it affects the lateral cortex or anterior bundle of the corticosus, it will have paralytic paraplegia, which affects the anterior horn cells or cauda equina of the spinal cord, resulting in flaccid paraplegia. The lower limbs feel disappeared. If there are other serious combined injuries, it should be actively treated to rescue the lives of the wounded. Conservative treatment and surgical treatment can then be used depending on the degree of stability of the spine. basic knowledge Sickness ratio: 0.05% Susceptible people: no special people Mode of infection: non-infectious Complications: cerebrospinal fluid leakage constipation
Cause
Causes of lumbar fractures
Cause:
Compression fractures are mainly caused by the violent movement of the head and feet, which causes the spine to suddenly and excessively flex. Due to the flexion of the spine, the external force concentrates on the front of a vertebral body, and is also squeezed by the upper and lower vertebral bodies. Therefore, the vertebral body is compressed and wedge-shaped, and is displaced backward to damage the spinal cord or cauda equina. If it affects the lateral cortex or anterior bundle of the corticosus, it will have paralytic paraplegia, which affects the anterior horn cells or cauda equina of the spinal cord, resulting in flaccid paraplegia. The lower limbs feel disappeared.
Prevention
Lumbar fracture prevention
Avoid damage and pay attention to daily life safety.
1. First aid: If the injured person is still crushed by rubble or earthwork, do not forcefully expose the exposed limbs to prevent damage to blood vessels, spinal cords and fractures. The person who is pressed against the injured person should be removed immediately. The fracture of the spine is often accompanied by a fracture of the neck and lumbar vertebrae.
2, cervical spine fractures should be packed with clothes and pillows on both sides of the head and neck to make them fixed.
3, such as thoracolumbar spine fractures, so that the injured lying on the hard board bed, the sides of the body with pillows, bricks, clothes tight, fixed spine is straight. When carrying, three people need to work at the same time. The specific method is: three people are kneeling on the side of the injured person, one person shoulders the shoulder, one person holds the waist and hips, one person holds the lower limbs, cooperates, and puts the patient supine position on the hard plate stretcher. The waist is padded with a placket.
4, the body wound part of the bandage, rinse the wound, stop bleeding, dressing.
5, complete or incomplete fracture injury, should be fixed at the scene and prevent complications, especially to take the fastest way to the hospital, should be closely observed during the escort.
(1) Suspicious spinal fractures. Immediately after spinal cord injury, first aid is required for spinal fractures.
(2) Hard bed, stretcher and door panel are used for transportation, and soft bed cannot be used. It is forbidden for one person to hold the back and should be lifted by 2 to 4 people to prevent the spinal cord and spinal cord injury from being aggravated.
(3) When carrying, let the injured person's lower limbs close together, the two upper limbs are attached to the waist side, and the position of the injured person is kept straight.
6, when the chest, waist, abdomen damage, in the handling, the waist should be padded with small pillows or clothing.
Complication
Lumbar fracture complications Complications cerebrospinal fluid leakage constipation
(1) Spinal cord and nerve root injury: It is the most serious complication in spinal surgery. It is more common in the operation of hemostasis, hemorrhage caused by shock or pressure on the spinal cord, the impact of the underlying disease; nerve root damage is caused by the stimulation of the device, direct contusion or excessive traction of the nerve. Postoperative attention should be paid to the sensory activity and urination of the extremities in order to detect abnormalities in time and report to the doctor for treatment. In order to reduce nerve edema, improve symptoms, preventive intravenous application of hormones, mannitol and furosemide and other neurological swelling drugs.
(2) Cerebrospinal fluid leakage: Due to old fractures or severe stenosis of the original spinal canal, the posterior longitudinal ligament and the dural sac are severely adhered, and the dural sac is damaged by surgical separation or removal of the posterior longitudinal ligament. Once there is drainage or blood washing, the drainage is more than 500ml in 24 hours. Immediately, the incision negative pressure drainage is changed to the common drainage bag drainage, and the pillow is laid flat. After the operation, strict neck braking and incision partial use 1kg sand are adopted. The bag is pressurized. For patients with dizziness and vomiting, raise the tail of the bed 30 ° - 45 °, and give the head low foot high. At the same time, report to the doctor, follow the doctor's advice, intravenous infusion of isotonic solution, if necessary, the incision is encrypted and sutured.
(3) Gastrointestinal complications: Early anterior lumbar vertebral surgery, when the spine is fixed in the extension position; autonomic dysfunction; electrolyte imbalance; or stimulation of autonomic nerves due to retroperitoneal hematoma, slowing intestinal peristalsis in bed, often appearing Abdominal distension, abdominal pain, constipation and other symptoms. For those with severe abdominal distension, they should be fasted. After excluding acute abdomen, they can be hot-applied to the abdomen, intramuscular injection of neostigmine needles, or oral senna, rhubarb water, and if necessary, continuous gastrointestinal decompression and enema. Instruct the patient to perform the contraction exercise of the abdominal muscles, and inform the patient to develop bed defecation and regular bowel movement habits.
(4) Incision infection: It usually occurs 3 to 5 days after surgery. The main reason is that the patient's general condition is poor, the preoperative preparation is not sufficient, the intraoperative aseptic operation is not strict, and the drainage tube is not removed in time to cause retrograde infection. It is characterized by elevated body temperature, leukocytosis, local pain in the incision with redness and exudation, and even purulent secretion. The key to controlling infection is prevention, including the correct use of perioperative antibiotics, aseptic operation during surgery, close observation of the incision after surgery, dressing change and replacement of the drainage tube to strictly perform aseptic operation and strengthen nutritional support.
(5) Internal fixation loose and fracture lumbar vertebrae fractures: internal fixation is mostly short segment fixation, which is subject to high pressure, which is easy to cause screw fatigue bending, loosening and broken nails, thus affecting nerve function and recovery of fractured vertebral body, and later There are signs of low back pain, weakness, and limited mobility. The main reasons are biological factors, anatomical factors, and factors related to vertebrae. Therefore, in addition to the operator's careful operation, it is necessary to inform the patient that it is not appropriate to get out of bed early, but early exercise of the back muscles. After 4 weeks, get out of bed under the protection of the brace or belt waist after 6 weeks to prevent the internal fixation from failing.
Symptom
Symptoms of lumbar vertebrae fractures Common symptoms Thoracic or lumbar spinal cord injury Thoracic and lumbar vertebral compression fractures Thoracic and lumbar spine injuries severe pain Acute urinary retention Both lower limbs sudden paralysis
1. Local pain, tenderness, and snoring pain.
2. Paraspinal muscle tension, limited lumbar motion, can not stand up and stand up.
3. The spinous process of the damaged part is kyphosis or an angular deformity occurs.
4. Abdominal distension and abdominal pain are mainly caused by the posterior peritoneal hematoma caused by the fracture, which stimulates the abdominal plexus to cause abdominal muscle reflex tension or paralysis.
5. Acute urinary retention caused by spinal cord injury or posterior peritoneal hematoma caused by bladder sphincter reflex sputum.
6. Lumbar spinal cord injury performance: sensory, motor and anal, bladder sphincter dysfunction appear below the affected plane. Injury of the lumbosacral vertebra can cause compression, contusion or rupture of the cauda equina, manifested as flaccid paralysis of the lower extremities, loss of sensation, and sphincter dysfunction in the perineal region.
Examine
Lumbar fracture examination
1. Neurological examination: In addition to the injury of the spine itself, the spinal nerve function must be thoroughly examined to determine the plane of the spinal cord injury. Including sensory and motion examination, reflex examination, anal examination.
2. Imaging examination: X-ray examination can determine the location and type of fracture. CT examination determined that the displaced fracture block violated the degree of spinal canal and found a bone or intervertebral disc that protruded into the spinal canal. Magnetic resonance imaging is extremely valuable for determining spinal cord injury status.
Diagnosis
Diagnosis and diagnosis of lumbar fracture
According to its clinical manifestations and X-ray examination, the disease can be clearly diagnosed without identification. However, it is necessary to pay attention to the clinical occurrence of fractures, whether it is a simple fracture or a pathological fracture caused by the patient's own disease. In the case of abnormal bone disease caused by the patient's original disease, a slight force can cause a fracture. In this case, it occurs more frequently and needs to be strictly observed and diagnosed.
