and Lumbar Spine Fractures and Dislocations 胸腰椎骨折脱位ppt课件.ppt

Thoracic and Lumbar Spine Fractures and Dislocations: Assessment and Classification;Anatomy of Thoracic Spine;Anatomy of Lumbar Spine;Thoracolumbar Junction;Transition Zone:Predisposed to Failure;Patient Evaluation;Patient Evaluation;Clinical Assessment;Clinical Assessment;Radiographic Evaluation;Additional Imaging;CT Scan;MRI Scan;Thoracolumbar Fractures Controversies;Classifications Necessary for……;B?hler 1930;Morphologic ClassificationWatson-Jones 38;Morphologic Classification Stable vs. UnstableNicoll 49;Holdsworth’62 Kelley Whitesides ’68 ;Anatomic Classification2 Column Theory Holdsworth 62;Anatomic Classification3 Column TheoryDenis 83;McAfee Classification;Load Sharing Classification McCormack, Spine 1994;;Mechanistic Classification AO ;AO Mechanistic ClassificationComplex subdivisions to include most fractures;Classification of thoracic and lumbar spine fractures: problems of reproducibilityA study of 53 patients using CT and MRI;Results; Vaccaro, A.R. et al, Spine 2005;Spine Trauma Study Group Thoracolumbar Injury Classification and Severity Scale (TLICS)Three Part Description;Injury Morphology;Neurologic Status;Posterior Ligamentous Complex ;TreatmentSpine Trauma Severity ScoreDetermined by:; Vaccaro, A.R. et al., J. Spinal Disorders Techniques 2005;Point System;Neurology-Point System;Posterior Soft Tissue Point System;MODIFIERS;Next Step - Direct TX;Treatment;ExamplesFlexion Compression Fx;Compression  Burst Fracture ;Compression Burst-Complete Neuro Injury;Compression  Burst-Complete injury;Translational/Rotation Injury;Surgical Decision making based off tenets of classification system Injury morphology Neurological status PLC integrity/injury stability ;Reliability/treatment validity at single institution Treatment validity exceptional- 96.4% Moderate agreement for PLC (66%) and mechanism (60%);Conflict: Mechanism vs Morphology;The Journal of Spinal Disorders and Techniques;Problems Inter-rater agreement on sub-scor