traumatic low paraplegia
Introduction
Introduction Traumatic paraplegia refers to a condition in which the spine is paralyzed by limbs below the site of spinal cord injury due to external forces. Due to direct or indirect violence, the injury site is prone to occur in segments with frequent spinal activity or physiological curvature conversion. The degree of injury is generally proportional to the magnitude of the violence. The diagnosis of this disease can be confirmed according to its medical history, symptoms, signs and X-ray findings. Traumatic paraplegia should be differentiated from paraplegia caused by spinal tuberculosis and tumor, and can be identified by X-ray film and other examinations.
Cause
Cause
The cause of traumatic low paraplegia:
According to the degree of spinal cord injury and pathological changes, it can be divided into three types: spinal shock, spinal cord compression and destruction of the spinal cord itself.
(1) Spinal shock type: There is no anatomical change in the spinal cord itself, and there is no pressure edema or other space-occupying lesions around the spinal cord, which only appears as a functional temporary conduction interruption. Clinical examination, incomplete movement, sensation, reflex and visceral function below the injury plane, generally complete or most of the recovery after 1 to 3 weeks, without any sequelae of organic disease.
(B) spinal cord compression type: is a secondary injury, can be caused by the following factors, forming a mechanical compression of the spinal cord. Such as spinal cord injury, local tissue congestion, edema, due to blood supply disorders, edema aggravation, so that the spinal cord is more severe, usually lasting 1 to 2 weeks. Intraspinal hemorrhage, epidural rupture and hemorrhage, due to the large arachnoid space, it is not easy to cause spinal cord compression in the early stage. Intramedullary hemorrhage can cause damage to adjacent nerve cells and nerve fibers. The gray matter of the spinal cord is more likely to bleed than the white matter. This bleeding is sometimes extensive and can involve several spinal segments. Fractures, dislocations or foreign body compressions, displaced vertebral bodies, broken bone fragments, prominent intervertebral disc tissue, broken intercostal ligaments, or other foreign bodies can compress the spinal cord or cauda equina. Spinal arachnoid adhesions, due to spinal cord contusion, subarachnoid hemorrhage, damaged tissue, scar tissue formation, can produce arachnoid adhesions or the formation of pseudocysts, oppression of the spinal cord and cauda equina nerve roots.
(C) the spinal cord itself, the degree of damage can be very different, mild injury, such as the sudden drop of the spinal cord, the spinal cord itself has no obvious organic changes, often showing spinal shock, after recovery from Zhejiang, the prognosis is better. Severe injury, epidural hematoma can occur, with the absorption of the hematoma, most of the function can be restored, leaving only a small part of the sequelae. Extremely severe injury can occur when the spinal cord is completely transected, nerve cells are destroyed, and nerve fibers are broken, resulting in irreversible lifelong paralysis.
Examine
an examination
Related inspection
Brain Doppler Ultrasound (TCD) Blood routine bedside fluoroscopy and intraoperative perspective EMG random motion examination
Examination and diagnosis of traumatic low paraplegia:
(1) Spinal shock: a complete flaccid paralysis secondary to the injury segment after spinal cord injury, accompanied by various clinical phenomena of loss of reflex, sensation, and sphincter function. In the case of minor injuries, this performance can be restored within hours or days without leaving sequelae. If the degree of injury is heavier, this performance may last for a long time. It usually takes 3 to 6 weeks before the spontaneous activity of the spinal cord below the injury segment gradually appears.
(b) Sensory impairment: All kinds of sensations are lost below the damage plane. After the recovery of spinal cord shock, the feeling can gradually appear. Sometimes there may be some sensory retention in the anus and perineum during the spinal shock period, indicating that the spinal cord injury is incomplete.
(3) Motor function: After the loss of the spinal cord in the transverse injury, the motor function below the injury segment disappears completely, but the muscle tension is gradually increased and the reflex is filled. Partially injured people may gradually develop muscle autonomic activity after recovery from the spinal cord shock stage, but the muscle group under the jurisdiction of the damaged segment may exhibit tension relaxation, atrophy, and disappearance of tendon reflex.
(4) Reflection: After the disappearance of the shock period, the reflection of the limbs gradually becomes hyperthy, and the muscle tension changes from relaxation to sputum.
(5) Bladder function: Different types of neuronal bladder may occur in spinal cord injury at different stages. In the spinal cord shock phase, it shows a tension-free bladder, and when the shock gradually recovers, it manifests as reflex bladder and intermittent urinary incontinence. When the spinal cord returns to reflex, stimulating the skin of the lower extremities can produce involuntary reflex urination. In the advanced stage, it is characterized by contracture and bladder.
(6) autonomic nervous system dysfunction: such as high fever, no sweat, slowing of bowel movements, constipation and so on.
Diagnosis
Differential diagnosis
Differential diagnosis of traumatic low paraplegia:
The diagnosis of this disease can be confirmed according to its medical history, symptoms, signs and X-ray findings. Traumatic paraplegia should be differentiated from paraplegia caused by spinal tuberculosis and tumor, and can be identified by X-ray film and other examinations.
diagnosis:
(1) Spinal shock: a complete flaccid paralysis secondary to the injury segment after spinal cord injury, accompanied by various clinical phenomena of loss of reflex, sensation, and sphincter function. In the case of minor injuries, this performance can be restored within hours or days without leaving sequelae. If the degree of injury is heavier, this performance may last for a long time. It usually takes 3 to 6 weeks before the spontaneous activity of the spinal cord below the injury segment gradually appears.
(b) Sensory impairment: All kinds of sensations are lost below the damage plane. After the recovery of spinal cord shock, the feeling can gradually appear. Sometimes there may be some sensory retention in the anus and perineum during the spinal shock period, indicating that the spinal cord injury is incomplete.
(3) Motor function: After the loss of the spinal cord in the transverse injury, the motor function below the injury segment disappears completely, but the muscle tension is gradually increased and the reflex is filled. Partially injured people may gradually develop muscle autonomic activity after recovery from the spinal cord shock stage, but the muscle group under the jurisdiction of the damaged segment may exhibit tension relaxation, atrophy, and disappearance of tendon reflex.
(4) Reflection: After the disappearance of the shock period, the reflection of the limbs gradually becomes hyperthy, and the muscle tension changes from relaxation to sputum.
(5) Bladder function: Different types of neuronal bladder may occur in spinal cord injury at different stages. In the spinal cord shock phase, it shows a tension-free bladder, and when the shock gradually recovers, it manifests as reflex bladder and intermittent urinary incontinence. When the spinal cord returns to reflex, stimulating the skin of the lower extremities can produce involuntary reflex urination. In the advanced stage, it is characterized by contracture and bladder.
(6) autonomic nervous system dysfunction: such as high fever, no sweat, slowing of bowel movements, constipation and so on.
