high paraplegia
Introduction
Introduction to high paraplegia High paraplegia refers to a transverse lesion that occurs at a higher level in the spinal cord. Medically, paraplegia caused by transverse spinal cord lesions above the second thoracic vertebra is generally referred to as high paraplegia, and paraplegia caused by spinal cord injury below the third thoracic vertebra is called lower limb paraplegia. High paraplegia usually has quadriplegia, and the prognosis is poor. Others are the same as paraplegia of the lower extremity. The spine or accessory fracture of the spine, the displaced vertebral body or the bone piece protruding into the spinal canal, may oppress the spinal cord or the horsetail, causing it to occur to varying degrees. The injury, the injured spinal cord is below the plane, the sensory movement and reflex of the limb disappear completely, and the bladder and anal sphincter function are completely lost, which is called complete paraplegia. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: constipation, incontinence, hemorrhoids, pulmonary embolism, urinary incontinence
Cause
High paraplegia
Spinal fractures (35%):
Spinal fractures or fractures and dislocations and spinal cord or cauda equina, which is a high paraplegia caused by trauma. In addition, high paraplegia caused by tumors in the spinal canal is generally seen in vertebral hemangioma and vertebral giant cell tumor.
Spinal cord disease (33%):
It is understood that the cause of high paraplegia is mainly caused by transverse spinal cord lesions above the second thoracic vertebra. Most patients with high paraplegia are suddenly injured in normal labor and accidents, such as car accidents, work injuries, and natural disasters.
Congenital diseases (25%):
Congenital or early onset disease is also one of the causes of high paraplegia. Due to congenital dysplasia, spinal cord damage gradually appears with age. Or acute spinal cord injury that occurs under the induction of trauma, eventually leading to paraplegia.
Prevention
High paraplegia prevention
Patients with high paraplegia have long-term illness, long-term bed rest, and many complications. If they are not properly cared for at work, they are life-threatening at any time. According to the patient's clinical characteristics, formulate practical nursing methods, cooperate with doctors to take reliable and favorable nursing measures, do a good job in bedside handover and do a good job in prevention of complications, psychological care, and health education to achieve cooperation. Give comfort and encouragement in the spirit, make the patient self-reliant and face the reality; give careful care in life, cheer up the patient, build confidence to overcome the disease, actively cooperate with treatment and care, shorten bedtime, and eliminate complications happened.
Complication
High paraplegia complications Complications constipation fecal incontinence hemorrhoids pulmonary embolism urinary incontinence
First, relieve common symptoms of the digestive tract: such as constipation, fecal incontinence, flatulence.
Second, deep vein thrombosis and pulmonary embolism: often occurs within one month after spinal cord injury.
Third, hemorrhoids.
Fourth, urinary tract infection: spinal cord injury or spinal cord transection caused by spinal cord shock, motor reflex is inhibited by bladder relaxation, filling urinary incontinence.
Symptom
High paraplegia symptoms Common symptoms constipation lumbar muscles under the abdomen tenderness upper abdominal pain
1. Loss of function: After the spinal cord shock period disappears during the transverse injury, the motor function below the injury segment disappears completely, but the muscle tension is gradually increased and the reflex is filled. This is one of the most common problems in paraplegic patients, most of which are manifested after the postoperative shock period. For this problem, experts from Beijing 304 Hospital introduced that the function above the injury plane can be restored through rehabilitation training, and the damage plane can also be used first. Nerve repair techniques lower the lesion plane and then exercise.
2. Loss of sensation: Complete flaccid paralysis secondary to the injury segment after spinal cord injury, accompanied by various clinical phenomena of reflex, sensory, and sphincter loss. Care should be taken in the care of such patients. For example, if the patient cannot feel warm and cold, the corresponding cause can cause frostbite; and the sphincter disorder is the main cause of incontinence.
3, urinary incontinence: the spinal cord urinary center is damaged, the human urine can not be introduced, the brain can not pass the control information of urination, so the patient does not feel urine. Experts said that as long as the problem of incontinence and incontinence is not completely transverse injury, most of them can be controlled by the later rehabilitation exercise.
4, muscle atrophy: the muscle strength is reduced, muscle volume is reduced, and muscle atrophy, and due to lack of nutrition can be accompanied by a series of pathological symptoms such as dry skin, desquamation, this pathological symptoms occur in the later rehabilitation training The impact is great. Therefore, when the family members are nursing, they should pay attention to the affected limbs of the appropriate active patients and avoid these symptoms.
5, pain: waist pain when coughing. Examination showed visible lumbar curvature, physiological lordosis decreased or disappeared, the affected side straight leg elevation test was positive but the patient's erythrocyte sedimentation rate and body temperature were normal. This kind of pain is divided into residual limb pain and phantom limb pain. It needs professional identification and treatment. Our hospital has done surgery and pain relief treatment, and the effect is ideal.
Examine
High paraplegia check
1. Pain: Pain from the upper abdomen to the foot for 24 hours, sometimes as a tens of thousands of needles, sometimes as a knife, sometimes as a fire, and the entire lower body is as stiff as a cement.
2. : There will be sputum from the waist to the feet, and allergies to the sound, sudden sound will aggravate the pain and paralysis.
3. No sweat from the waist to the feet.
4. Urine closed and closed, urinary catheters need to be used to discharge, the stool needs to use "opening dew" drugs to help discharge.
Diagnosis
High paraplegia diagnosis
diagnosis
Medically, paraplegia caused by transverse spinal cord lesions above the second thoracic vertebra is generally referred to as high paraplegia, and paraplegia caused by spinal cord injury below the third thoracic vertebra is called lower limb paraplegia. High paraplegia usually has quadriplegia, and the prognosis is poor. The other aspects are the same as the lower extremity paraplegia.
Differential diagnosis
Spinal vertebrae or accessory fractures, displaced vertebral bodies or bone fragments protruding into the spinal canal, the possibility of compressing the spinal cord or the horse's tail, causing different degrees of damage, the injured spinal cord is below the plane, the limb's sensorimotor movement, the reflection completely disappears, the bladder If the anal sphincter function is completely lost, it is called complete paraplegia. After cervical spinal cord injury, the upper limbs have neurological dysfunction, which is quadriplegia.
