颈椎损伤(英文版).pptx

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1、cervical spine injuriesCERVICAL SPINE CERVICAL SPINE Seven Cervical VertebraeEight pairs of Cervical spinal nervescervical spine injuries Main Cause of the disease TRAUMARTA leading cause Mode of injury Road side accidents (RSA)Fall from height Accidental injury due to carrying heavy weight over hea

2、d Sports injuriesTrivial Trauma in Pre-existing Spondylotic spine Mode of injury Mechanism of Injury NO STUDY TILL DATE WHICH CORELATES SEVERITY OF INJURY WITH MODE OF TRAUMA/INJURYcervical spine injuries Cervical spine injuries with cord injury without cord injury cervical spine injuriesPRESENTING

3、COMPLAINTSPainQuadriplegiaMyotome and Dermatome TestingNerve Root LevelSensory TestingMotor TestingReflex TestingC1-C2Front of faceNeck flexionN/AC3Lateral face and skullLateral flexionN/aC4SupraclavicularShoulder shrugN/AC5Lateral shoulder/upper armShoulder abductionBicipital(musculocutaneous)C6Lat

4、eral lower arm and hand(thumb and index finger)Elbow flexion and wrist extensionBrachialradial(musculocutaneous)C7Palmar aspect of hand middle 3 fingersElbow extension and wrist flexionTriceps(radial)C8Medial lower arm and handFinger flexion and thumb extensionN/AT1Medial elbow and upper armFinger a

5、bductionN/ADERMATOME DISTRIBUTIONINVESTIGATIONSRadiologicalX-rays AP,Lat ,Swimmers view ,odontoid viewCT ScanMRI must for patients with neurological lossDIGNOSTIC PRE OPERATIVE X-RAYSLateral viewTop of T1 visible in idle lat view Three smooth arcs maintainedVertebral bodies of uniform heightOdontoid

6、 intact and closely applied to C1AP viewSpinous processes straight and spaced equallyIntervertebral spaces roughly equalOdontoid viewOdontoid intactEqual spaces on either side of odontoidLateral margins of C1 and C2 alignDIGNOSTIC PRE OPERATIVE CT SCANMRISIGNS OF INSTABILITYAP translation 3.5mmspino

7、us process widening on lateralrotation of facets on lateralfacet joint wideningmalalignment of spinous process on AP viewlateral tilting of vertebral body on AP viewLAT VIEW X RAYLAT VIEW X RAYPrevertebral soft tissue Nasopharyngeal spaceRetropharyngeal space Retrotracheal spaceAP and Odontoid ViewI

8、nitial TreatmentCAB Immobilization rigid cervical orthosis-Philadelphia collar Spine Boardcervical traction with Halo or Gardner wells tongs.Initial TreatmentnoYesTreatment-Conservative Halo tractionGardner wells tongsSurgical TreatmentStabilisationAnteriorPosteriorCombined/Global fusionSurgical Tre

9、atmentSurgical TreatmentSurgical TreatmentSurgical TreatmentFerguson and Allen ClassificationClassification is Based on position of neck at time of injury and dominant forceCompression and FlexionVertical CompressionDistraction FlexionCompression ExtensionCompression DistractionLateral FlexionOccipi

10、to-atlantal Dislocationhyperextension distraction and rotation of craniovertebral junctionsevere neurological injuries from complete C1 quadriplegia to incomplete syndromesSurgical TreatmentATLAS FRACTUREAxial compression injuriesneurological injury rare3 typesJefferson fracture-direct compression a

11、nd lateral masses forced apartasymmetric load fracture ant or post to mass and displaces itposterior arch fractures with an extension moment through itJefferson FractureCompression fracture of the bony ring of C1Odontoid viewDisplacement of the lateral masses of vertebrae C1 beyond the margins of th

12、e body of vertebra C2.Jefferson FractureOdontoid Fracture Axis15%all cervical fracturesusually hyperflexion with anterior displacementassoc injuries to C1 commonneurological deficit in 15-25%casesOdontoid FractureBest seen on the lateral viewTypesI Fx through superior portion of densII Fx through th

13、e base of the densIII Fx that extends into the body of C2Odontoid FractureOdontoid FractureOdontoid FractureType 1 -Philadelphia collar for 6-8 weeksType 2 undisplaced-halo immobilization displaced-Primary C1-C2 fusion after reduction in traction most recommend if displacement 4-5mm Type 3 Halo vest

14、 immobilization after reduction in traction(3-4 months)C2 Hangmans FractureFx through the pars reticularis of C2 secondary to hyperextensionHangmans C2 FractureTraumatic spondylolithesisType 1 isolated minimally displaced fracture of ring with no angulationType 2 more unstable flesion type/extension

15、 type or listhetic type displaced 3mm and angulation of C2-C3 disk space ALL,PLL Disc can be interruptedType 3 rare,anterior dislocation of C2 facets on C3 with 2 extension fracturing neural archThree types of Hangmans fracture TREATMENTType 1Conservative-rigid cervical orthosisType 2closed reductio

16、n with tractionhalo vest immobilizationType 3Surgical management -C2-C3 fusionClay Shovelers FractureFracture of a spinous process C6-T1Signs:Spinous process fracture on lateral view.Ghost sign on AP view (i.e.double spinous process of C6 or C7 resulting from displaced fractured spinousBurst Fractur

17、eFracture of C3-C7 axial compression.CT is required for all patients to evaluate extent of injury.Wedge FractureCompression fracture resulting from flexion.Buckled anterior cortex.Loss of height of anterior vertebral body.Anterosuperior fracture of vertebral body.DISLOCATIONSBilateral Facet Dislocat

18、ionUnilateral Facet DislocationCervical spine injuries with Vertebral artery occlusion Prevention is Better than CureWhen meditating over a disease,I never think of finding a remedy for it,but instead,a means of preventing it”louis pasteur Thanks Thankscervical spine injuries.Known is a drop.unknown is an ocean.Dr.Kalaivanan Kanniyan Assistant Professor OrthopaedicsArthroplasty and Adult Reconstruction UnitSMCH,Saveetha University,chennai,Tamil Nadu,India.