脊柱和骨盆骨折2中山大學(xué)外科學(xué)(編輯修改稿)
2025-02-16 11:16 本頁面
【文章內(nèi)容簡介】 ervical Spine ? Hot amp。 Spice ? Recent advances in internal fixation have allowed its use in the cervical spine Traumatic Spondylolisthesis of the Axis (Hangman Fractures) ? Incurred during the hanging of criminals ? Motor vehicle accidents with hyperextension of the head ? The occiput is forced down against the posterior arch of the atlas, which in turn is forced against the pedicles of C2(Axis) A lateral radiograph shows the C2 vertebral body in this 42yearold woman who was in a car crash to be sagittally rotated and anteriorly displaced relative to the C3 body. B: As expected from the plain radiographs, the axial CT images confirm bilateral fractures through the narrow part of the pars (small arrows) Type IIa hangman39。s fracture ? C: Satisfactory closed reduction could be achieved in a halo using an extended head position. D: A partial loss of reduction but solid healing of the fracture occurred after 4 months of halo immobilization. The patient has remained plaintfree after pletion of her nonoperative management. ?Nonoperative treatment of type IIa hangman39。s fracture Lower Cervical Spine (C37) ? 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 Flexion pression injury Thoracic and Lumbosacral Fractures ? The treatment of unstable fractures and fracturedislocations of the thoracic and lumbar spinecontroversial ? Nonoperative treatment ? Open reduction and rigid internal fixation with posterior instrumentation ? laminectomy alone is contraindicated in fracturedislocations because it fails to relieve the anterior pression and increases spinal instability ? This flexiondistraction injury (seat belt fracture) was the result of an automobile accident The Spinal Cord Injury脊髓損傷 ? 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 pared 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脊髓休克 ? Rarely lasts longer than 24 hours, it may last for days or weeks ? A positive bulbocavernosus reflex or return of the anal wink reflex indicates the end of spinal shock ? If no motor or sensory function below the level of injury can be documented when spinal shock ends, a plete spinal cord injury is present and the prognosis is poor for recovery of distal motor or sensory function Spinal Cord Syndromes ? Definition ? An inplete spinal cord injury is one in which some motor or sensory function is spared distal to the cord injury ? A plete spinal cord injury is manifested by total motor and sensory loss distal to the injury ? When the bulbocavernosus reflex is positive and no sacral sensation or motor function has returned, the paralysis will be permanent and plete in most patients. Spinal Cord Syndromes ? Resulting from inplete traumatic lesions ? The greater the sp
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