颈椎损伤(英文版).pptx

CervicalSpineInjuries CERVICALSPINE CERVICALSPINE SevenCervicalVertebraeEightpairsofCervicalspinalnerves CervicalSpineInjuries MainCauseofthediseaseTRAUMA RTA leadingcause Modeofinjury Roadsideaccidents RSA FallfromheightAccidentalinjuryduetocarryingheavyweightoverheadSportsinjuriesTrivialTraumainPre existingSpondyloticspine Modeofinjury MechanismofInjury NOSTUDYTILLDATEWHICHCORELATESSEVERITYOFINJURYWITHMODEOFTRAUMA INJURY CervicalSpineInjuries Cervicalspineinjurieswithcordinjurywithoutcordinjury CervicalSpineInjuries PRESENTINGCOMPLAINTSPainQuadriplegia MyotomeandDermatomeTesting DERMATOMEDISTRIBUTION INVESTIGATIONS RadiologicalX raysAP Lat Swimmersview odontoidviewCTScanMRImustforpatientswithneurologicalloss DIGNOSTIC PREOPERATIVE X RAYS LateralviewTopofT1visibleinidlelatviewThreesmootharcsmaintainedVertebralbodiesofuniformheightOdontoidintactandcloselyappliedtoC1APviewSpinousprocessesstraightandspacedequallyIntervertebralspacesroughlyequalOdontoidviewOdontoidintactEqualspacesoneithersideofodontoidLateralmarginsofC1andC2align DIGNOSTIC PREOPERATIVE CTSCAN MRI SIGNSOFINSTABILITY APtranslation 3 5mmspinousprocesswideningonlateralrotationoffacetsonlateralfacetjointwideningmalalignmentofspinousprocessonAPviewlateraltiltingofvertebralbodyonAPview LATVIEW XRAY LATVIEW XRAY PrevertebralsofttissueNasopharyngealspaceRetropharyngealspaceRetrotrachealspace APandOdontoidView InitialTreatment CABImmobilizationrigidcervicalorthosis PhiladelphiacollarSpineBoardcervicaltractionwithHaloorGardnerwellstongs InitialTreatment NO YES Treatment Conservative Halotraction Gardnerwellstongs SurgicalTreatment StabilisationAnteriorPosteriorCombined Globalfusion SurgicalTreatment SurgicalTreatment SurgicalTreatment SurgicalTreatment FergusonandAllenClassification ClassificationisBasedonpositionofneckattimeofinjuryanddominantforceCompressionandFlexionVerticalCompressionDistractionFlexionCompressionExtensionCompressionDistractionLateralFlexion Occipito atlantalDislocation hyperextensiondistractionandrotationofcraniovertebraljunctionsevereneurologicalinjuriesfromcompleteC1quadriplegiatoincompletesyndromes SurgicalTreatment ATLASFRACTURE Axialcompressioninjuriesneurologicalinjuryrare3typesJeffersonfracture directcompressionandlateralmassesforcedapartasymmetricloadfractureantorposttomassanddisplacesitposteriorarchfractureswithanextensionmomentthroughit JeffersonFracture CompressionfractureofthebonyringofC1OdontoidviewDisplacementofthelateralmassesofvertebraeC1beyondthemarginsofthebodyofvertebraC2 JeffersonFracture OdontoidFracture Axis 15 allcervicalfracturesusuallyhyperflexionwithanteriordisplacementassocinjuriestoC1commonneurologicaldeficitin15 25 cases OdontoidFracture BestseenonthelateralviewTypesI FxthroughsuperiorportionofdensII FxthroughthebaseofthedensIII FxthatextendsintothebodyofC2 OdontoidFracture OdontoidFracture OdontoidFracture Type1 Philadelphiacollarfor6 8weeksType2undisplaced haloimmobilizationdisplaced PrimaryC1 C2fusionafterreductionintraction mostrecommendifdisplacement 4 5mm Type3Halovestimmobilizationafterreductionintraction 3 4months C2Hangman sFractureFxthroughtheparsreticularisofC2secondarytohyperextension Hangman sC2FractureTraumaticspondylolithesis Type1isolatedminimallydisplacedfractureofringwithnoangulationType2moreunstableflesiontype extensiontypeorlisthetictypedisplaced 3mmandangulationofC2 C3diskspaceALL PLLDisccanbeinterruptedType3rare anteriordislocationofC2facetsonC3with2extensionfracturingneuralarch ThreetypesofHangman sfracture TREATMENT Type1Conservative rigidcervicalorthosisType2closedreductionwithtractionhalovestimmobilizationType3Surgicalmanagement C2 C3fusion ClayShoveler sFracture FractureofaspinousprocessC6 T1Signs Spinousprocessfractureonlateralview GhostsignonAPview i e doublespinousprocessofC6orC7resultingfromdisplacedfracturedspinous BurstFracture FractureofC3 C7axialcompression CTisrequiredforallpatientstoevaluateextentofinjury WedgeFracture Compressionfractureresultingfromflexion Buckledanteriorcortex Lossofheightofanteriorvertebralbody Anterosuperiorfractureofvertebralbody DISLOCATIONS BilateralFacetDislocation UnilateralFacetDislocation CervicalspineinjurieswithVertebralarteryocclusion PreventionisBetterthanCure Whenmeditatingoveradisease Ineverthinkoffindingaremedyforit butinstead amean