spinal cord injury
Introduction
Introduction to spinal cord injury A spinal cord blade injury is an open injury caused by a sharp, sharp instrument that stabs the spinal cord. Spinal cord blade injuries are mostly incomplete and have a good prognosis. basic knowledge Proportion of disease: 0.005% of trauma patients Susceptible people: no special people Mode of infection: non-infectious Complications: abscess
Cause
Cause of spinal cord blade injury
(1) Causes of the disease
The spinal cord blade injury is mostly caused by crime. The victim suffers from the attack from the back. The most common wounded device is the dagger, followed by the axe. There are screwdrivers, bicycle spokes, sickles and sharpened bamboo, wooden sticks, etc. The blade can be pulled out immediately or it can be retained or partially broken into the body.
1. Pathway to puncture the spinal cord
(1) translaminar space: the most common, the spinous process of the spine protrudes to the rear, and the transverse process protrudes to the side and rear. A longitudinal groove is formed between the two, and the blade enters the ditch easily after entering from the back. The lamina gap or the vertebral plate slides up and down and then enters the gap. Therefore, nearly half of the spinal cord blade injuries are half-cut injuries.
(2) transforaminal: almost all of the elongate sharps entering the intervertebral space can cause damage to the spinal cord, nerve roots and blood vessels.
(3) translaminar: After sharply piercing the sharp blade into the lamina, the blade itself and the lamina fracture piece damage the spinal cord.
2. There are two ways of spinal cord injury:
(1) Direct injury: The blade or fracture piece directly stabs the spinal cord, nerve root or blood vessel.
(2) Hedge damage: the blade enters the side of the spinal canal, and the spinal cord is squeezed to the opposite side, causing a contralateral impact injury.
(two) pathogenesis
Simple spinal cord blade injury is rarely fatal, and there is no need for surgical exploration. Therefore, there are few sources of early pathological data. For autopsy of those who died from the combined injury, some or all of the spinal cord can be removed, or only contusion, edema of the section. , valgus, dura mater can be damaged, there may be hematoma in the spinal canal, root artery injury, spinal cord necrosis, softening, the sharper the wound, the greater the possibility of damage to the blood vessels.
Prevention
Spinal cord injury prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Spinal cord injury complications Complications
Spinal cord injury is accompanied by other organ damage. If the abdominal organ is damaged, it may be missed due to lack of pain and painful muscle tension. It may also be combined with Brodie abscess, which is a broken blade tip remaining in the vertebral body. Chronic vertebral abscess caused by surgery needs to be removed.
Symptom
Spinal Cord Blade Injury Symptoms Common Symptoms Paralysis Spiral Shock
Wound characteristics
The wound is almost on the back side of the body, 1/3 is at the midline or near the midline. It can be single or multiple, but generally only one injury to the spinal cord. The direction of the injury is on the chest. The waist and the waist are mostly horizontal or downward. The size of the wound is related to the type of the blade. The smallest one is only a small hole, which needs to be carefully examined before it can be found.
2. Cerebrospinal fluid leakage
4% to 6% of the wounds have cerebrospinal fluid leakage, which stops within 2 weeks.
3. Nervous system symptoms
According to Peacock's 450 cases, the injury site accounted for 63.8% in the thoracic segment, 29.6% in the cervical segment, 6.7% in the lumbar segment, 20.9% in complete injury, and 70% in incomplete injury, typical or atypical. Brown-Sequard sign, spinal cord shock generally recovered within 24h, with arterial injury, the symptoms are more serious, below the plane of injury can be due to sympathetic nerve paralysis, vasodilation and elevated body temperature.
Examine
Spinal cord injury examination
A large fracture piece may be found on the X-ray film. The segment of the injury may be determined according to the position of the tip of the retention blade or the position of the residual portion after the fracture. The positive and lateral slices should be photographed in a regular manner, parallel to the direction of the projection. The long edge device can only be a little shadow. If it overlaps the vertebrae, it is not easy to find. On the chest radiograph and the abdominal plain film, pay attention to the presence of pneumothorax, pleural effusion and underarm free gas.
Axial CT can clearly show the location of residual blade or fracture piece or find intraspinal hematoma, abscess and other space-occupying lesions, but artifacts caused by metal foreign bodies often affect observation.
Magnetic resonance can clearly show the degree of spinal cord injury. The typical half-cut injury is the transverse defect on the side of the spinal cord in the coronal position. The defect area is long T1, long T2 signal, and there is no such test when metal is left.
When the symptoms of the nervous system deteriorate and need to be surgically explored, but it is inconvenient to perform CT or MRI, in order to determine the relationship between the injured and the spinal canal, spinal iodine angiography should be performed to understand whether there is pressure or obstruction.
Diagnosis
Diagnosis and treatment of spinal cord injury
According to the history of back injury and the symptoms of spinal cord damage, the diagnosis can be confirmed.
A definitive diagnosis can usually be made without a disease that requires special identification.
