Thoracic and lumbar burst fractures
Introduction
Introduction to thoracolumbar burst fractures A spine composed of multiple motion segments can cause damage when subjected to excessive movement or external force. Injury violence includes excessive flexion, extension, compression, separation, shearing, and rotational force, which can cause damage beyond physiological limits. According to the Denis three-column concept, burst fractures have become an important clinically significant type of spinal fractures, such as improper handling, which can cause accidents. Denis et al. emphasize that when the posterior wall of the vertebral body and the posterior fibrous annulus, ie, the medial column including the posterior longitudinal ligament, are damaged, it can cause instability in the flexion state, and this involves the anterior column and The fracture of the middle column is defined as a burst fracture. basic knowledge Sickness ratio: 0.0001% Susceptible people: no specific population Mode of infection: non-infectious Complications: spinal cord injury
Cause
Causes of thoracolumbar burst fractures
(1) Causes of the disease
More due to car accidents and falls.
(two) pathogenesis
The occurrence of burst fractures is related to high-energy trauma, more common in car accidents and fall injuries, chest 10 ~ waist 2 segments, especially chest 12, waist 1 and waist 2 are most susceptible, when the axial load acts on the spine, and continues to increase, When the final load exceeds its ability to resist compression, mechanical damage occurs, and the vertebra bursts radially, resulting in a decrease in vertical height and an increase in shaft diameter. At the same time, fragments of bone and soft tissue are easily displaced rearward. Finally, the vertebral canal with relatively low pressure and relatively low pressure is directly related to the axial load. Due to the destruction of the vertebral bone structure, the spine is shortened, and the posterior wall of the vertebral body is the identification of the burst fracture. The standard of compression fracture, the posterior wall of the vertebral body is not only important for the structure and biomechanics of the spine, but also important for the protection of the nerve. The intact posterior wall of the vertebral body can prevent the kyphosis of the spine and protect the nerve in the spinal canal. Subject to external damage, if the ligament structure connecting the adjacent upper and lower vertebral bodies is destroyed, even if the posterior wall is intact, the spine may be misaligned, and the barrier is lost. At the time of injury, or in the process of displacement and instability in the future, it is easy to cause damage to nerve tissue.
Although the spine (vertebral ganglion) is shortened when the vertebrae collapse, if the ligament and the annulus can remain intact, the injured vertebral segments may not be horizontally displaced. In the treatment of burst fractures, the clinical stability of the affected vertebral segments must be considered. The instability of the spine is caused by the simultaneous damage of the anterior and middle columns, rather than the damage of the anterior column. The previous fractures were classified as stable fractures, but it is now recognized that burst fractures involve at least the Denis three-column. The two columns, accompanied by displacement and deformation, especially in the sagittal plane, have realistic and potential hazards.
The sagittal position and tilt angle of the vertebrae are not only important for determining the natural outcome of the injury, but also important for determining whether treatment is needed. When the spine is flexed, the posterior structure is subjected to tension and the anterior structure is subjected to pressure. The interspinous ligament, the ligamentum flavum, the joint capsule and the lamina resist the tension at the rear, and the main supporting structure of the axial load is located in front, including the vertebral body, endplate and intervertebral disc.
The annulus, anterior longitudinal ligament and posterior longitudinal ligament provide a constraint. They cooperate with the small joints, allowing the vertebral segments to move freely at six angles. When the height of the vertebral body is lost, the small joint can withstand 16% to 33% compression. Load, but prone to small joint fractures.
Prevention
Prevention of thoracolumbar burst fracture
In daily life production, we must pay attention to protect ourselves and prevent damage.
Complication
Complications of thoracolumbar burst fractures Complications spinal cord injury
Thoracic and lumbar burst fractures such as injuries and bone marrow can be complicated by sputum. Recovery is difficult.
Symptom
Thoracic and lumbar burst fracture symptoms Common symptoms Thoracolumbar vertebral compression fractures chest or lumbar spinal cord injury severe pain
It has typical clinical manifestations of spinal fractures, severe pain, does not dare to move the body, and is positive for conduction pain; about half of the cases are accompanied by symptoms of spinal cord injury, ranging from incomplete to complete paralysis.
Examine
Examination of thoracolumbar burst fractures
No relevant laboratory tests.
X-ray plain film can clearly show the fracture line and its displacement as a clear positioning diagnosis. In addition, the depth and extent of the broken bone piece (block) invading the spinal canal should be determined. For those who are difficult to judge, CT scan or routine CT scan should be performed. Tomography.
Diagnosis
Diagnosis and diagnosis of thoracolumbar burst fractures
Diagnostic criteria
1. The history of trauma is more common in vertical vertical violence.
2. The clinical manifestations are heavier than the general spinal fractures, and more with spinal cord involvement symptoms.
3. Imaging changes X-ray plain film can clearly show the fracture line and its displacement as a clear positioning diagnosis. In addition, the depth and extent of the broken bone piece (block) invading the spinal canal should be determined. Regular CT scan or tomography.
Differential diagnosis
Generally not confused with other diseases.
