脊柱损伤.ppt

Outline Incidence Types Clinical signs Radiological signs Spinal shock Management Incidence 10 - 15 per million 18 - 35 years Male - 3:1 RTA 51% - cars Domestic 16% Industrial 11% Sports 16% - diving incidents Self harm 5% occupation natural disaster! Types Cervical 40% Thoracic 10% Lumbar 3% Dorso lumbar 35% Any 14% About 5-7% of the total body fractures Anatomy Spine anatomy Anterior column - Anterior longitudinal ligament+ Anterior annular ligament and anterior half of VB. Middle column – Posterior long. Lig. + Posterior annular ligament +Posterior half of VB. Posterior Column – Lig flavum + superior Interspinous lig + intertransverse capsular lig + neural arch + pedicle spinous process. Armstrong-Denis Classification 前柱 前纵韧带、椎体及椎间盘的前半部 中柱 椎体及椎间盘的后半部及后纵韧带 后柱 椎体附件及其韧带 Level of Spinal injury Neurological level is at the most lowest segment with normal motor sensory function Difficult to determine : - as most muscle efferents receive fibres from more than one level - Closed cord lesions may extend over several cms. - Dermatomes have imprecise boundaries. Vertebral number and Cord level C2 – C7 = add +1 for cord level T1 – T3 = add +1 T4 – T6 = add +2 T7 – T9 = add +3 T10 = L1, L2 level T11 = L3, L4 level L1 = sacro coccygeal segments 脊髓休克（ Spinal shock ） 伤后损伤平面以下运动、感觉、括约肌功能完全丧失，数周自行恢复 脊髓挫伤（contusion of spinal cord） 脊髓出血、水肿 脊髓裂伤（laceration of spinal cord） 脊髓部分或完全断裂 脊髓受压（compression of spinal cord） 脊髓被压迫 Spinal shock Transient physiological reflex depression of cord function – ‘concussion of spinal cord’（脊髓震荡） Loss anal tone（紧张性）, reflexes, autonomic control within 24-72hr Flaccid paralysis （弛缓性麻痹）bladder bowel and sustained Priapism Lasts even days till reflex neural arcs below the level recovers. Degrees of injury Complete - flaccid paralysis （弛缓性麻痹） － total loss of sensory motor functions Incomplete - mixed loss - Anterior sc syndrome - Posterior sc syndrome - Central cord syndrome - Brown sequa