Combined and multiple spinal injury
Traumatology / / August 12, 2017
victims with multiple fractures of the spine and combined account for 8.6% of all multiple injuries and 21.4% of associated injuries.Among men predominate in patients 21-50 years of age (78%), among the victims over 60 years, mainly dominated by women (77%).The causes of this injury data are: falls from height (62.4%), direct hit, mainly by means of transport (28.5%), squeezing.Multiple fractures of the vertebral bodies are observed in 18.3%: fractures of the vertebral bodies 2 - 12.8%, 3 - at 4.4%, 4 - at 1.1%.The most frequently injured four upper lumbar and thoracic vertebrae XII.
main features of the spine
diagnosis of vertebral fracture
Familiar elements of the survey (anamnesis, inspection, palpation, and check the mobility of bone fragments) in severe injury can not be fulfilled, as history may be absent if the person is alcoholic intoxication, shock, or traumatic brain coma.
After rail and road accidents victims are usually unable to describe the mechanism of injury, inspection and palpation are difficult because of the inability to turn the patient.The most gentle way to palpation of the spine in these patients is summing hands behind his back so that the left hand is slightly raised her spine, and fingers of his right hand made palpation, finding and projecting the painful spinous process of a broken vertebra.This method can be found palpation and painful point in fractures of the transverse processes of the spine.In all cases, acute pain in the lumbar region, which arise from injury at the slightest movement, trying to stand up, turn over in bed, should be suspected fractures of the transverse processes.Pain in the lumbar region at the fracture processes are much more intense than in fractures of the vertebral body, which contributes to their early diagnosis.
Soreness in fractures of the vertebral body can be detected by light tremors in the head, pelvis, ribs, lower limb (if not damaged).Dosed load along the spine axis (at an angle) is usually distinct causes pain.Careful neurological examination of the affected significantly complements and refines the diagnostics of damages.The forced position of the head, the tension of the neck muscles and a sharp restriction of mobility of the cervical spine - the most important symptoms of its fracture in this department.The final and decisive stage of diagnosis is radiography of the spine in two projections, and profile pictures (most important for diagnosis) should be performed in the patient supine.In connection with the possibility of multiple vertebral fractures overview images must be performed on large films.For complex fractures (arches, articular processes, perelomovyvihah) may require sighting and special X-rays (in the oblique projections), and tomography, the ability to perform that must be solved individually in each case.
first aid for injuries of the spine
The victim carried a total analgesia intramuscular promedola (1 mL of 1% solution) and diphenhydramine (1 mL of 1% solution).Extremely carefully transferred the injured from the scene and placed on a hard stretcher (shield!), Being careful not to change the position of his body.Affected with a suspected spinal injury can not lift for the upper and lower limbs.In the supine position under your neck and under your lower back cushions enclose improvised clothes, bags with sand.Particular difficulty is transportation of victims with damage to the cervical spine.
Transport immobilization for fractures of the vertebrae, and - bus Elan;b - bus Bashmakova
When forced long distance transport is shown pouring salt solutions also necessary to monitor the function of the bladder (catheter!).
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treatment and rehabilitation in case of injuries of the spine
treatment of multiple compression fractures of the vertebral bodies does not differ significantly from the treatment of single fractures.It begins with a mandatory novocaine blockade locations fracture at the time of hospitalization.For fractures of adjacent vertebrae 2-4 is used and a high roller.When multiple vertebral fractures, spaced apart rollers are used (or narrow bags with linseed) at respective levels of the spine.An effective method of treatment of fractures of the lower thoracic and lumbar vertebrae is hanging the victim on gamachke.With multiple fractures of the vertebral bodies and processes used by the method of gradual reclination functional treatment Gorinevskoy and Dreving.
reclination spine using "gamachka" and dempferirovannyh rods
Surgical interventions are permissible only after a persistent improvement of the general condition of patients (not earlier than 2-3 weeks).Fixation of the spine using metal structures promotes early immobilization of patients, reduces the period of bed rest, enables an early start to an active medical gymnastics.Treatment of multiple fractures of the transverse processes in the absence of other injuries is conducted by conventional methods: laying the patient on a hard bed (shield) at the position on the back for the time necessary to eliminate the severe pain;holding novocaine blockade, by putting a cushion under the knees bent (to relax the lumbar muscles), physiotherapy (5-7-day).
12 Aug, 2017
12 Aug, 2017