Spinal cord injury
Introduction
Introduction to spinal cord injury Spinal cord injury (spinalcordinjury) refers to spinal cord injury due to external direct or indirect factors, and various changes in motor, sensory and sphincter dysfunction, muscle tone abnormalities and pathological reflexes occur in the corresponding segments of the lesion. The extent and clinical manifestations of spinal cord injury depend on the location and nature of the primary injury. In Chinese medicine, it is caused by traumatic blood stasis caused by "back pain", "sputum syndrome", "sputum closure" and other disease syndrome categories. Spinal cord injury is the most serious complication of spinal injury and often leads to severe dysfunction of the limb below the injured segment. Spinal cord injury not only causes serious physical and psychological harm to the patient, but also imposes a huge economic burden on the whole society. basic knowledge The proportion of the disease: the incidence of this disease is about 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: upper gastrointestinal bleeding, acne, respiratory tract infection, autonomic dysfunction, constipation, stress ulcer, lower extremity venous thrombosis
Cause
Cause of spinal cord injury
First, the etiology and pathology of Western medicine
1. Open injuries are more common in wartime, and are often accompanied by spinal injuries. They are mainly found in bullets, knives, and explosive injuries. Blades, bruises, and bruises directly affect the spine, causing fractures or dislocations, which in turn cause the spinal cord. Damaged, the damage is consistent with the location of the external force, and the degree of damage is proportional to the magnitude of the external force. It can occur in any spinal cord and is most common in the chest. 2. Closed injuries are more common in peacetime, mainly in car accidents, fall injuries, sports sprains, spinal sprains, excessive weight, etc., causing excessive stretching, flexion, and torsion of the spine, causing spinal fractures, dislocations, and damage to the spine attachments. Or ligament and spinal cord blood supply damage, which in turn causes closed injury. Pathologically, according to the severity of the injury, it can be divided into spinal cord concussion, spinal cord contusion, spinal cord compression or transverse, intraspinal hematoma.
Second, the pathogenesis of Chinese medicine
The disease belongs to the category of traumatic syndrome of traditional Chinese medicine. Due to direct or indirect violent damage, the brain is shocked, the medullary sputum is blocked, the yang can not reach the brain, the gods are lost, and the limbs are lost; or the blood vessels are damaged, the blood spills outside the veins, blocking the medullary sputum The disease is caused by the aging of the veins.
Prevention
Spinal cord injury prevention
The disease is caused by traumatic factors, so there is no effective preventive measures, pay attention to the safety of production and life, and avoid the key to the prevention and treatment of this disease.
For patients with surgical treatment, the prevention of complications should be actively prevented. It is also necessary to pay attention to early functional exercise. It can be started from passive exercise and gradually replaced with active exercise to promote the best condition of the limbs and improve the quality of life after rehabilitation.
Complication
Spinal cord injury complications Complications upper gastrointestinal bleeding acne respiratory infection autonomic dysfunction constipation stress ulcer lower extremity venous thrombosis
Patients with this disease may have the following complications due to their weak body resistance and the inability to get out of bed.
1, hemorrhoids, which is caused by local long-term compression, resulting in blood circulation disorders;
2, urinary tract infection, spinal cord injury patients due to long-term infusion of the indwelling catheter, resulting in decreased bladder defense mechanism, the infection rate is quite high;
3, joint stiffness and deformity;
4. Prevention and treatment of respiratory tract infections;
5. Autonomic dysfunction;
6, constipation;
7, stress ulcers, mostly occurred in patients with large trauma, due to large stimulation, may cause changes in autonomic nerve function, digestive dysfunction, and gastric and duodenal stress ulcers, upper gastrointestinal bleeding.
8, lower extremity venous thrombosis, the patient's blood is hypercoagulable after trauma, venous return is slow, long-term bed rest is easy to cause lower extremity venous thrombosis.
Symptom
Symptoms of spinal cord injury Common symptoms Thoracic or lumbar spinal cord injury Sensory disorder Spinal cauda equina involvement Spinal cord compression Spinal cord spinal cord lesions Transverse spinal cord injury
Spinal cord injury is a serious complication of spinal fracture. The spinal cord or cauda equina nerve produces different degrees of damage due to the displacement of the vertebral body or the fragmentation of the broken bone in the spinal canal. The thoracolumbar injury causes the lower limbs to feel and exercise, which is called paraplegia. After the cervical spinal cord injury, the upper limbs also have neurological dysfunction, which is referred to as "four sputum".
1. Spinal cord injury
During spinal cord shock, there is a flaccid paralysis below the plane of injury, loss of movement, reflex and sphincter function, loss of plane and urination of the sensory loss, and gradual progression to spastic paralysis after 2-4 weeks, manifested as increased muscle tone. The sacral reflex is hyperthyroidism, and the pathological vertebral body tract sign appears. The thoracic spinal cord injury is paraplegic. The cervical spinal cord injury is characterized by quadriplegia. The quadriplegia of the upper cervical vertebrae injury is spastic paralysis. The quadriplegia of the lower cervical spine injury Due to the destruction of the cervical neck enlargement and nerve roots, the upper limbs appear to be flaccid paralysis, and the lower limbs are still spasmodic. Spinal cord hemisection: also known as Brown-Sequard sign. Below the injury plane, the movement and deep feeling of the ipsilateral limb disappeared, and the pain and warmth of the contralateral limb disappeared. Pre- Spinal Cord Syndrome: severe pressure on the front of the cervical spinal cord can sometimes cause occlusion of the anterior central artery of the spinal cord, quadriplegia, lower extremity and upper limb paralysis, but the lower limbs and perineum still maintain a sense of position and deep feeling, sometimes even retaining Light feeling. Most of the spinal cord central tube syndrome occurs in cervical hyperextension injuries. The cervical spine tube undergoes a sharp solvent change due to cervical hyperextension. The spinal cord is anteriorly compressed by the pleated ligament, intervertebral disc or spur, causing the conduction bundle around the central canal of the spinal cord to be damaged, showing the quadriplegia below the injury plane, and the upper limb to the lower limb. , no feeling of separation, poor prognosis.
2, spinal cone injury
The normal human spinal cord terminates at the lower edge of the first lumbar vertebral body. Therefore, the first lumbar vertebrae fracture can cause conic injury of the spinal cord, which is characterized by saphenous sensation of the perineal skin, loss of sphincter function and uncontrollable dysfunction, and lower limbs. Feelings and movements remain normal.
3, cauda equina injury
The cauda equina is derived from the sacral spinal cord of the second lumbar vertebrae and generally terminates at the lower edge of the first atlas. The cauda equina injury is rarely complete. It appears as a flaccid paralysis below the injury plane, with sensory and motor dysfunction and loss of sphincter function, decreased muscle tone, paralysis of the tendon, and no pathological vertebral bundle sign.
4. The degree of loss of various functions after spinal cord injury can be expressed by the paraplegia index.
A "0" indicates that the function is completely normal or near normal. "1" represents the loss of the functional part. "2" represents a complete loss or near complete loss of function. The function of the limb's autonomous movement, feeling and two stools is generally recorded. After the addition, the patient's paraplegic index is obtained. If a patient's spontaneous movement is completely lost, and the other two are partially lost, the patient's paraplegia index is 2+1+1=4, and the three functionally complete paraplegia indexes. When it is 0, the three functions are completely lost, and the truncation index is 6. From the knot index can roughly reflect the extent of spinal cord injury, development, easy to record, but also compare treatment effects.
Examine
Spinal cord injury examination
The auxiliary examination methods for this disease are as follows:
1. X-ray examination routinely takes the lateral position of the spine and, if necessary, the oblique position. The heights of the anterior and posterior vertebral bodies were measured at the time of reading and compared with the superior and inferior vertebrae; the pedicle spacing and the width of the vertebral body were measured; the spacing of the spinous processes and the width of the intervertebral disc space were measured and compared with the upper and lower adjacent intervertebral spaces. The height of the pedicle on the positive lateral position was measured. X-rays can basically determine the location and type of fracture.
2. CT examination is helpful to determine the degree of invasion of the spinal canal by the displaced fracture block and to find the bone or intervertebral disc that protrudes into the spinal canal.
3. MRI (magnetic resonance) examination is extremely valuable for determining the state of spinal cord injury. MRI can show edema and hemorrhage in the early stage of spinal cord injury, and can show various pathological changes of spinal cord injury, spinal cord compression, spinal cord transection, spinal cord incomplete injury, spinal cord atrophy or cystic changes.
4. SEP (somatosensory evoked potential) is a method for measuring the conduction function of the somatosensory system (mainly by the spinal cord). It is helpful to determine the degree of spinal cord injury. There is now MEP (Motion Induced Potential).
5. Jugular vein compression test and myelography jugular vein compression test have certain reference significance for judging spinal cord injury and compression. Myelography is useful for the diagnosis of old traumatic spinal stenosis.
Diagnosis
Diagnosis and diagnosis of spinal cord injury
As the disease of the retroperitoneal hematoma on the autonomic nerve stimulation, intestinal peristalsis slowed down, often abdominal distension, abdominal pain and other symptoms, sometimes need to be differentiated from abdominal organ injury. In addition, it should be noted that spinal fractures, burst fractures, spinal cord edema, hemorrhage and rupture are more likely, simple compression fractures have a lower probability of spinal cord injury, but there are still spinal cord injuries, and even some spine found no fractures There is spinal cord injury. Therefore, when the clinical symptoms are severe but not consistent with X-ray and CT examinations, MR I should be performed in time to observe the spinal cord condition.
