不稳定胸腰段骨折的治疗

目的 :总结不稳定胸腰段骨折的治疗经验。方法 :本组病例均为新鲜骨折 ,其中后壁完整或接近完整的压缩骨折 14例 ,采用后路Schanz钉复位的内固定方法 ;后壁有较大游离骨块的爆裂骨折 3例 ,采用前路减压Ventrofix固定。结果 :两组病人硬膜囊受压解除 ,恢复了脊柱生理弯曲 ,术后未发生断钉、断棒、脱出等并发症 ,神经功能不同程度恢复。结论 :区别不同骨折类型 ,采用Schanz和Ventrofix固定方法 ,手术中做到减压彻底、稳定脊柱 ,能取得良好的临床效果     

Missed cervical spine fracture: chiropractic implications

OBJECTIVE: To discuss the case of a patient with an anterior compression fracture of the cervical spine, which had been overlooked on initial examination. CLINICAL FEATURES: A 36-year-old man was seen at a chiropractic clinic 1 month after diving into the ocean and hitting his head on the ocean floor. He chipped a tooth but denied loss of consciousness. Initial medical examination in the emergency department did not include radiography, but an anti-inflammatory medication was prescribed. Radiographs taken at the chiropractic clinic 1 month later revealed an anterior compression fracture of the C7 vertebra, with migration of the fragment noted on flexion and extension views. INTERVENTION AND OUTCOME: The patient was referred back to his medical doctor for further evaluation and management.He was instructed to wear a Philadelphia collar for 4 weeks. During this time period, he reported "shooting" pain and tingling from his neck into his arms. The patient reported resolution of his neck and arm symptoms at 2.5 months after injury. Follow-up radiographs at 6 months after injury revealed fusion of the fracture fragment with mild residual deformity. At that time, the patient began a course of chiropractic treatment. CONCLUSION: After head trauma, it is essential to obtain a radiograph of the cervical spine to rule out fracture. Chiropractors should proceed with caution, regardless of any prior medical or ancillary evaluation, before commencing cervical spine manipulation after head and neck trauma.     

An important complication of upper cervical spine fracture: a case report.

A case report is presented of a patient who sustained a high cervical spine fracture, the possible mechanisms of injury and details of the fracture are discussed. The patient developed bilateral vagal nerve palsies 48 h after the accident. This complication was only recognized after dysphagia and an aspiration pneumonia developed. The complication of aspiration pneumonia was preventable. Meticulous and repeated examination of the cranial nerve function in this type of injury is recommended. Normal feeding should commence only when the cranial nerve function has been shown to be normal after repeated examination.     

Headache and the cervical spine: a critical review

Headache related to the cervical spine is often misdiagnosed and treated inadequately because of confusing and varying terminology. Primary headaches such as tension-type headache and migraine are incorrectly categorized as "cervicogenic" merely because of their occipital localization. Cervicogenic headache as described by Sjaastad presents as a unilateral headache of fluctuating intensity increased by movement of the head and typically radiates from occipital to frontal regions. Definition, pathophysiology, differential diagnoses and therapy of cervicogenic headache are demonstrated. Ipsilateral blockades of the C2 root and/or greater occipital nerve allow a differentiation between cervicogenic headache and primary headache syndromes such as migraine or tension-type headache. Neither pharmacological nor surgical or chiropractic procedures lead to a significant improvement or remission of cervicogenic headache. Pains of various anatomical regions possibly join into a common anatomical pathway, then present as cervicogenic headache, which should therefore be understood as a homogeneous but also unspecific pattern of reaction.     

不稳定性腰椎骨折患者围术期的护理

目的探讨不稳定性腰椎骨折患者围术期护理。方法回顾性分析43例不稳定性腰椎骨折患者围术期护理的临床资料。结果本组43例不稳定性腰椎骨折患者通过积极的手术治疗及围术期护理,减轻了患者的痛苦,促进了功能的恢复。结论适当的围术期护理对提高不稳定性腰椎骨折患者的治疗效果及并发症的预防起着重要的作用。     

Delayed presentation of unstable cervical spine injury with minimal symptoms

Emergency physicians are less likely to suspect the presence of a severe or unstable cervical spine injury in patients who have been ambulatory since the traumatic episode. We present the case of a man with multiple cervical fractures and a 75% anterior subluxation of C6 and C7 who did not seek medical care for six weeks after falling from a height. Previous reports of delayed or occult cervical spine injuries are reviewed. Physicians must aggressively search for injuries whenever a history of neck pain is present or a strong mechanism of injury exists, even if the patient has been ambulatory for days or weeks following the injury.     

Upper cervical spine chordoma: a case study.

Cervical chordomas are rare, slow-growing, but locally aggressive tumors. Predominantly found in people 50-69 years old, a chordoma arises from remnants of the primitive notochord. It is most often found in the sacrococcygeal or skull base areas. However, it can be found throughout the spine. Because chordomas are slow growing, they may reach considerable size before the patient becomes symptomatic. Surgical resection with a wide margin is the only curative procedure. Usually, because of tumor location and infiltration, this is not possible. Although this type of tumor is generally considered radioresistant, radiation therapy is often prescribed after surgical resection. The following case study illustrates the clinical presentation, surgical interventions, and neuroscience nursing considerations for a patient undergoing a posterior stabilization as well as a midline mandibulotomy-glossotomy approach for an upper cervical spine chordoma resection.     

颈椎骨折行前路手术39例围术期护理

目的:探讨颈椎骨折患者行前路手术围术期的护理方法。方法:对39例颈椎骨折行前路手术患者做好术前心理护理、气管推移训练、体位适应训练、呼吸功能训练,术后体位护理、呼吸道护理、引流管护理、病情观察、康复训练指导。结果:本组随访6个月~2年,FranrelA级1例,术后肢体功能无明显改善,B级2例恢复至C级,均未发生严重并发症。结论:对颈椎骨折行前路手术患者,加强围术期护理,可有效预防并发症发生,促进术后康复。     

Injury to the upper cervical spine: fracture versus congenital anomaly

As skull and cervical spinal radiographs are being obtained routinely on head and neck injuries, more incidental anomalies of the neck region are being detected. The differentiation of congenital anomaly from fracture can be difficult. The importance of this, however, cannot be underestimated because of the dire consequences of a missed cervical fracture. A case of such an anomaly and its presentation following injury is presented.     

The Canadian collar: a new cervical spine orthosis

We developed a cervical collar (the Canadian collar) in response to the requirements of occupational therapists who manage arthritis patients. This orthosis overcomes the problems of heat and inadequate support common to many soft collars. The collar is constructed from nylon and polyvinyl chloride tubing, clipped together by nylon junctions, and from chin and breastplate supports of molded nylon rod. Preliminary clinical trials have been conducted on 20 patients, 15 of whom had arthritis. An additional 60 patients with various disabilities have been fitted. The collar has been readily accepted by patients, therapists, orthotists, and physicians.     

The cervical spine: radiologist's perspective

This article provides an essential curriculum in cervical spine radiology. It discusses the uses of plain radiographs, MR imaging, computed tomography (CT), and CT myelography, in addition to the methodologies of discography, epidural injections under visualization, and facet and nerve root injections. It explains how radiographic images of the cervical spine can differentiate tumors, inflammation, recent or prior trauma, and the range of discal, arthritic, neural, and vascular cervical pathologies and, just as importantly, when they cannot.     

Cervical collars are insufficient for immobilizing an unstable cervical spine injury

Background

Cervical orthoses are commonly used for extrication, transportation, and definitive immobilization for cervical trauma patients. Various designs have been tested frequently in young, healthy individuals. To date, no one has reported the effectiveness of collar immobilization in the presence of an unstable mid-cervical spine.

Study Objectives

To determine the extent to which cervical orthoses immobilize the cervical spine in a cadaveric model with and without a spinal instability.

Methods

This study used a repeated-measures design to quantify motion on multiple axes. Five lightly embalmed cadavers with no history of cervical pathology were used. An electromagnetic motion-tracking system captured segmental motion at C5-C6 while the spine was maneuvered through the range of motion in each plane. Testing was carried out in intact conditions after a global instability was created at C5-C6. Three collar conditions were tested: a one-piece extraction collar (Ambu Inc., Linthicum, MD), a two-piece collar (Aspen Sierra, Aspen Medical Products, Irvine, CA), and no collar. Gardner-Wells tongs were affixed to the skull and used to apply motion in flexion-extension, lateral bending, and rotation. Statistical analysis was carried out to evaluate the conditions: collar use by instability (3 × 2).

Results

Neither the one- nor the two-piece collar was effective at significantly reducing segmental motion in the stable or unstable condition. There was dramatically more motion in the unstable state, as would be expected.

Conclusion

Although using a cervical collar is better than no immobilization, collars do not effectively reduce motion in an unstable cervical spine cadaver model. Further study is needed to develop other immobilization techniques that will adequately immobilize an injured, unstable cervical spine.     

The radiology of cervical spine injury.

Cervical spine injury is a frequent sequelae of accidental trauma. Clinical evaluation often fails to raise adequate suspicion of an underlying injury. Radiologic assessment frequently reveals recognizable signs of damage ranging from fractures to joint and soft tissue injuries. This paper reviews the pathomechanics, clinical and radiologic features of the most common patterns of cervical spine injury.     

颈椎侧块钢板治疗下颈椎骨折脱位

目的　观察颈椎侧块钢板治疗颈椎骨折、脱位的疗效。方法　对采用颈椎侧块钢板治疗 5 4例颈椎骨折、脱位患者的临床资料进行回顾性分析。结果　术后患者均无神经、血管并发症。通过 4～ 36个月的随访 ,颈椎侧块钢板对颈椎固定牢靠 ,无螺钉松脱及钢板断裂现象 ,同时对颈椎滑脱有良好的复位作用。全部达到骨性愈合 ,脊髓功能除 5例按Frankle分级为A级者术后 3个月无明显改善外 ,其余均有不同程度改善。结论　颈椎侧块钢板适用于需要后路减压的颈椎骨折、脱位 ,对其有良好的复位和固定作用 ,有利于脊髓功能的恢复 ;本方法还具有短节段固定 ,术后仅需轻便外固定 ,可早期活动等优点。该手术有一定风险 ,因此要求术者技术熟练 ,操作规范。