胡侦明-Fractures-of-spine-and-pelvic.ppt

FRACTURES OF SPINE AND PELVIC Department of Orthopaedic Surgery 1st Affiliated Hospital of Chongqing Medical University Fracture of the spine Three-column classification of spinal instability. Illustrations of anterior, middle, and posterior columns cause isolated failure of the anterior column and result from forward flexion. They are rarely associated with neurological deficit the anterior and middle columns fail because of a compressive load, with no loss of integrity of the posterior elements the anterior and middle columns fail in compression, and the posterior column is disrupted. The posterior column can fail in compression, lateral flexion, or rotation. There is a tendency for posttraumatic kyphosis and progressive neural symptoms because of instability are horizontal avulsion injuries of the vertebral bodies caused by flexion about an axis anterior to the anterior longitudinal ligament. The entire vertebra is pulled apart by a strong tensile force the flexion axis is posterior to the anterior longitudinal ligament. The anterior column fails in compression while the middle and posterior columns fail in tension. This injury is unstable because the ligamentum flavum, interspinous ligaments, and supraspinous ligaments usually are disrupted are characterized by malalignment of the neural canal, which has been totally disrupted. Usually all three columns have failed in shear. At the affected level, one part of the spinal canal has been displaced in the transverse plane 1.Flexion injury the result of compression of anterior column and distraction of posterior column ⑴ anterior subluxation: caused by rupture of the ligament of posterior column ( complete or incomplete) ⑵ bilateral facet dislocations: extreme flexion—rupture of ligament of middle and posterior column (may with approximately 50% anterior subluxation of the vertebral body. In a more severe case, may have full vertebral body width displaceme