Thoracolumbar fractures
Introduction
Introduction to thoracolumbar fracture Thoracolumbar fracture refers to the destruction of the continuity of the thoracolumbar spine due to external forces. This is the most common spinal injury. In young and middle-aged patients, high-energy injury is the main cause of injury, such as car accidents, high-altitude fall injuries. Older patients have osteoporosis due to their own, and the damage factors are mostly low-violent injuries, such as slipping and falling. Patients with thoracolumbar fractures often have neurological impairment, and because of the high-energy injury caused by injury, often combined with other organ damage, this brings great difficulties and challenges for treatment. basic knowledge The proportion of illness: the incidence rate is about 0.001%-0.002%, mostly due to trauma Susceptible people: no special people Mode of infection: non-infectious Complications: pneumonia
Cause
Causes of thoracolumbar fractures
Indirect violence (35%):
Most common. It is more common to fall from a height, after the hips or feet are on the ground, the force is uploaded to cause the waist; or the heavy object falls from the height to the impact head, shoulders, and back, and the force is transmitted downward to the waist to cause the fracture; some elderly people have bones Severe looseness, some minor injuries, such as bumping on the bus, sitting down on the ground, etc., can also cause vertebral fractures.
Muscle pull (25%):
When the muscles of the lumbosacral region suddenly contract strongly, considerable tensile stress can be generated, which often causes attachment of vertebral bodies, such as transverse processes, spinous processes, etc.; serious diseases such as tetanus or other nervous system The resulting contraction of muscles can lead to compression fractures of the thoracolumbar vertebral body.
Direct violence (15%):
Usually rare. It can be seen in traffic accidents, firearm injuries, or direct blows on the waist. Such injuries often cause spinal cord injuries and have serious consequences such as varying degrees of paralysis.
Prevention
Thoracic and lumbar fracture prevention
1. Quit smoking, control the amount of alcohol consumed, eat less irritating greasy food, and eat more foods rich in vitamins and crude fiber.
2. It is forbidden to sit for a long time, stand for a long time, bend over for a long time, carry too much weight, avoid trauma, and avoid daily strenuous exercise.
3, supplement full vitamin D: eat more foods rich in vitamin D (such as fish, liver, egg yolk, etc.), and as much sun as possible to promote the absorption of vitamins.
Complication
Complications of thoracolumbar fractures Complications pneumonia
Early surgery in patients with spinal fractures with long bone fractures can prevent complications in patients with bed rest, such as pneumonia, hemorrhoids, etc.
Symptom
Symptoms of thoracolumbar fractures Common symptoms Motor dysfunction severe pain Lower extremity neuropathic pain Low back pain
1. Local manifestations of injury: severe local pain after trauma, accompanied by tenderness at the injury site.
2, the performance of nerve damage: the injured trunk and the lower limbs feel numbness, weakness, or knife-like pain, dysfunction of the bowel movements (can not defecate or two incontinence), severe cases can completely disappear the lower limbs.
3, the performance of combined injuries: abdominal pain, difficulty breathing, shock, loss of consciousness and so on.
Examine
Thoracic and lumbar fracture examination
Film degree exam
(1) X-ray film
Conventional positive and lateral plain films are the most basic method of examination for suspected thoracolumbar fractures. The alignment of the thoracolumbar and lumbar vertebrae can be well observed on the positive lateral plain film. Many thoracolumbar fractures not only have vertebral fractures but also kyphosis in the injured area. The orthotopic plain film can understand the alignment of the spine, the presence or absence of scoliosis, and the location of the spinous process. If the distance between the vertebral bodies of the same vertebral body is widened, it indicates that the vertebral body is subjected to compressive external force, resulting in vertebral compression or burst fracture. If the lateral displacement of the vertebral body occurs on the anterior slice, the intervertebral space becomes narrow or disappears, suggesting that the damage through the intervertebral disc, the lateral displacement obviously indicates the possibility of dislocation or fracture of the joint, indicating the instability of the injured segment. Lateral plain film can understand the alignment of the vertebral body, the presence of lumbar lordosis, the loss of vertebral height, the presence or absence of dislocation, and the local kyphosis angle.
(2) CT
Patients with thoracolumbar fractures should have a CT scan if they have neurological damage or suspected instability. CT has obvious advantages in distinguishing thoracolumbar vertebral compression fractures and rupture fractures compared with plain films. CT can show laminar fractures, facet fractures, and pedicle injuries, which are difficult to diagnose on ordinary plain films. . On the axial plane, CT can be used to evaluate the invasion of the vertebral body to the spinal canal. Three-dimensional reconstruction of CT can help us to observe the sequence of the spine and understand the structure and damage of the spine from various planes.
(3) MRI
Patients with thoracolumbar fractures should undergo MRI if they have neurological damage or suspected disc damage or posterior ligament structure damage. MRI can clearly show images of spinal cord and soft tissue. MRI can help us to identify disc injury, epidural hematoma, spinal cord edema, and soft tissue injury, which cannot be replaced by other imaging studies. Usually T1 is like understanding the basic anatomy, T2 image reflects the pathological process and ligament structure; sagittal position understands the existence of hematoma and distinguishes the relationship between bone and spinal cord and disc and ligament without damage; axial T1 like evaluation of dura mater External space, spinal cord, and intervertebral foramen and other structures.
Diagnosis
Diagnosis and diagnosis of thoracolumbar fractures
diagnosis
Diagnosis can be performed based on clinical manifestations and examinations.
Differential diagnosis
It needs to be differentiated from thoracolumbar degenerative changes. The intervertebral disc tissue bears the weight of the human trunk and upper limbs. With the increase of age, excessive activity and overload bearing, the strain in daily life and labor is heavier than other tissues, making the lumbar vertebrae Accelerate the appearance of aging, and under the influence of external force, following the rational change of the pathology, the annulus fibrosus ruptures, the nucleus pulposus in the intervertebral disc protrudes, causing low back pain and nerve dysfunction.
