脊柱与骨盆骨折2 中山大学 外科学.ppt

Fracture of Spine Pelvis 课时数 2 内容简介 脊柱骨折 脊髓损伤 骨盆骨折 问题？？？ 如何诊断脊柱脊髓损伤？ 骨盆骨折的治疗原则？ Fracture of Spine Pelvis Orthopedics Dep. Jin Wang Tips of This Talk Really difficult and complex Plenty of new words Even hard for residents Seat back Have fun Ask questions Following the brain storming Forget the test Spinal fractures脊柱骨折 Spinal Cord Injury脊髓损伤 The Injury of the spine Fractures and dislocations of the spine are serious injuries that most commonly occur in young people Nearly 43% of patients with spinal cord injuries sustain multiple injuries Anatomy of Vertebral Column Composed of alternating bony vertebrae and fibrocartilaginous discs that are connected by strong ligaments and supported by musculature that extends from the skull to the pelvis and provides axial support to the body A typical vertebra is composed of an anterior body and a posterior arch made up of two pedicles and two laminae that are united posteriorly to form the spinous process The three columns of the spine The anterior column (A) consists of the anterior longitudinal ligament, anterior part of the vertebral body, and the anterior portion of the annulus fibrosis The middle column (B) consists of the posterior longitudinal ligament, posterior part of the vertebral body, and posterior portion of the annulus The posterior column (C) consists of the bony and ligamentous posterior elements Evaluation of Spinal Injury HISTORY Mechanism of injury Common causes: motor vehicle accidents, falls, diving accidents, and gunshot wounds PHYSICAL EXAMINATION NEUROLOGICAL EVALUATION NEUROLOGICAL EVALUATION Sensory, motor, and reflex function, is important in determining prognosis and treatment Sensory Examination Dermatome landmarks---the nipple line (T4), xiphoid process (T7), umbilicus (T10), and inguinal region (T12, L1), as well as the perineum and perianal region (S2, S3, and S4) Evidence of sacral sensory sparing can establish the diagnosis of an incomplete spinal cord injury Motor Examination