外科脊柱骨盆骨折课件.pptVIP

A lateral radiograph shows the C-2 vertebral body in this 42-year-old woman who was in a car crash to be sagittally rotated and anteriorly displaced relative to the C-3 body. Hangmans fracture Satisfactory closed reduction could be achieved in a halo using an extended head position Nonoperative treatment of hangmans fracture Traction plaster or orthosis Lower Cervical Spine (C3-7) The primary goals of treatment Realign the spine Prevent loss of function of uninjured neurological tissue Improve neurological recovery Obtain and maintain spinal stability Obtain early functional recovery Compression flexion injuries Common C4-5 OR C5-6 Flexion compression injury C3-7 Treatment Non-op Plaster or orthosis, Halo Ring Op Decompression Front or back Fusion Thoracic and Lumbosacral Fractures The treatment of unstable fractures and fracture-dislocations of the thoracic and lumbar spine----controversial Nonoperative treatment Open reduction and rigid internal fixation with posterior instrumentation laminectomy alone is contraindicated in fracture-dislocations because it fails to relieve the anterior compression and increases spinal instability This flexion-distraction injury (seat belt fracture) was the result of an automobile accident Spinal Cord Injury脊髓损伤 The Spinal Cord InjurySuperman 4,500 years ago--- was described as “a disease one cannot treat” . Paralysis remains incurable Improved care has allowed patients with a spinal cord injury better function, improved quality of life, and prolonged survival Experience and research continue Spinal Cord Injury Overall, 85% of patients with a spinal cord injury who survive the first 24 hours are still alive 10 years later compared with 98% of patients of similar age and sex without spinal cord injury Regional trauma centers and increased training of paramedics and emergency medical technicians---- survival increased Spinal shock lasts for 1-6 weeks A positive bulbocavernosus reflex/ 球海绵体反射or return of the anal w