spinal fracture
Introduction
Introduction to spinal fracture Spinal fractures are very common, accounting for 5%-6% of total body fractures. Thoracic and lumbar segments are more common in spinal fractures. Spinal fractures can develop spinal cord or terminal cauda equina injury, especially cervical spine fractures, dislocations with spinal cord injury, reportedly up to 70%, can be severely disabled or even life-threatening. Each vertebra is divided into two parts, the vertebral body and the attachment. The entire spine can be divided into three columns: front, middle and back. The anterior column contains the anterior 2/3 of the vertebral body, the anterior segment of the annulus and the anterior longitudinal ligament; the posterior column contains the posterior 1/3 of the vertebral body, the posterior half of the annulus and the posterior longitudinal ligament, while the posterior column contains Posterior joint capsule, ligamentum flavum and spine attachments, articular processes and spine, and interspinous ligaments. The middle column and the posterior column envelop the spinal cord and the cauda equina nerve. The damage in this area can involve the nervous system, especially the damage of the middle column. The broken bone piece and nucleus pulposus tissue can protrude into the front of the spinal canal and damage the spinal cord, so for each Patients with spinal fractures must understand whether there is a column injury. The thoracolumbar spine (thorax 10 - waist 2) is at the intersection of two physiological amplitudes, and the mobility is large, which is the concentration of stress, so the fracture is very common. Violence is the main cause of thoracolumbar fractures. The direction of violence can be through the X, Y, and Z axes. There are six movements in the spine: compression, pulling, and rotation on the Y-axis: flexion, divine, and lateral movement on the X-axis and lateral flexion and anteroposterior movement on the Z-axis. There are three forces that can be used for the center axis: axial compression, axial pull and movement on the cross plane. The three causes do not exist at the same time, for example, axial compression and axial traction are not possible at the same time. Therefore, there are six types of injuries for thoracolumbar fractures and cervical spine fractures, respectively. basic knowledge The proportion of illness: 0.005% Susceptible people: more common male young adults Mode of infection: non-infectious Complications: Acne
Cause
Cause of spinal fracture
Trauma (85%)
Spinal fractures are more common in male young adults. It is caused by indirect external force. It is caused by the hip or foot landing and impact external force when it falls from the height to the thoracolumbar region. A few are caused by direct external force, such as house collapse and bruise, car crush or firearm injury. Severe cases can cause paraplegia and even life-threatening; improper compression of simple compression fractures can also leave chronic low back pain.
Prevention
Spinal fracture prevention
Pay attention to safety in production and life, and try to avoid trauma. Preventing the impact of external force on the buttocks or the foot when the height falls, causing a spinal fracture to the chest and lumbar region.
Complication
Spinal fracture complications Complications
Can be complicated by infection, hemorrhoids, injury ossification and so on.
Symptom
Spinal fracture symptoms Common symptoms Horsetail injury Spinal bone changes Spinal damage Sensory disorder Severe pain
1. Local pain in the spine after trauma, limited mobility, deformity, tenderness.
2, there may be incomplete or completely paralyzed performance. Such as feeling, loss of motor function, dysfunction and so on.
Examine
Spinal fracture examination
1. The exposed surface should be sufficient when examining the spine. The spinous process must be pressed one by one with the fingers. If local swelling and obvious local tenderness are found in the midline, it is suggested that the posterior column has been damaged. The thoracolumbar spine fracture is often Touched the deformity. Check for the presence of spinal cord or cauda equina injury. If there is a manifestation of nerve damage, the mechanism should be told to the family or companion, and recorded in the medical history card.
2, X-ray film is the preferred method of examination, the elderly feel slow, chest and lumbar spine fractures often complained of low back pain, simple lumbar spine will miss the lower thoracic spine fracture, it must be noted that the radiograph included the lower thoracic spine (T10 -12), usually take two films in the positive side, if necessary, add oblique tablets, on the oblique film can see the presence or absence of vertebral isthmus fracture. Because the front half of the cervical spine is an occult injury, there is no obvious fracture. It is easy to neglect and difficult to diagnose when examined by X-ray. If you read the film carefully, you can still find four characteristic X-ray performances:
(1) The gap between the spinous processes is widened.
(2) Intervertebral subluxation.
(3) Paraspinal muscle spasm causes the cervical spine to lose its normal lordotic arc. The above various manifestations are more pronounced in the flexion position.
(4) The microscopic protrusions on the anterior vertebral body of the next section indicate a slight vertebral compression fracture.
X-ray examination has its limitations. It can not show the pressure in the spinal canal. All patients with middle column injury or neurological symptoms should be examined by CT. CT examination can show the fracture of the vertebral body. It can also show whether the broken bone piece protrudes in the spinal canal, and can calculate how much the anteroposterior diameter and transverse diameter of the spinal canal are lost. The CT piece can not show the spinal cord injury. MRI should be performed if necessary. On the MRI, the signal changes caused by vertebral fractures and the hematoma in front can be seen. The abnormally high signal due to spinal cord injury can also be seen.
Diagnosis
Diagnosis and diagnosis of spinal fracture
1. Inquire about the medical history, the way of injury, the posture of the injured, and whether there is any feeling or movement disorder after the injury.
2, pay attention to multiple injuries, multiple injuries often combined with brain, chest, abdominal organs damage, we must first deal with emergencies, save lives.
3, the examination of the spine should be sufficient to expose the face, you must use your fingers to press the spinous process one by one from top to bottom, if found local swelling in the midline and obvious local tenderness, suggesting that the posterior column has been damaged, thoracolumbar spine fractures often Touched the deformity. Check for the presence of spinal cord or cauda equina injury. If there is a manifestation of nerve damage, the mechanism should be told to the family or companion, and recorded in the medical history card.
4, imaging examination helps to confirm the diagnosis, defects, damage, location and displacement, X-ray film is the preferred method of examination, the elderly feel slow, chest and lumbar spine fractures often complain of low back pain, simple lumbar spine The film will miss the fracture of the lower thoracic vertebrae. Therefore, it is necessary to indicate that the filming site includes the lower thoracic vertebra (T10-12). Usually, the two sides of the positive side are taken. If necessary, the oblique piece is added. On the oblique piece, you can see it. Whether there is a vertebral isthmus fracture. Because the front half of the cervical spine is an occult injury, there is no obvious fracture. It is easy to neglect and difficult to diagnose when examined by X-ray.
