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1、FractureofSpine&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？FractureofSpine&PelvisOrthopedicsDep.JinWangTipsofThisTalkReallydifficultandcomplexPlentyofnewwordsEvenhardforresidentsSeatbackHavefunAskquestionsFollowingthebrainstormingForgetthetestSpinalfr
2、actures脊柱骨折SpinalCordInjury脊髓损伤TheInjuryofthespineFracturesanddislocationsofthespineareseriousinjuriesthatmostcommonlyoccurinyoungpeopleNearly43%ofpatientswithspinalcordinjuriessustainmultipleinjuriesTraumaCenter&SpineCenterAnatomyofVertebralColumnComposedofal
3、ternatingbonyvertebraeandfibrocartilaginousdiscsthatareconnectedbystrongligamentsandsupportedbymusculaturethatextendsfromtheskulltothepelvisandprovidesaxialsupporttothebodyAtypicalvertebraiscomposedofananteriorbodyandaposteriorarchmadeupoftwopediclesandtwolami
4、naethatareunitedposteriorlytoformthespinousprocessThethreecolumnsofthespineTheanteriorcolumn(A)consistsoftheanteriorlongitudinalligament,anteriorpartofthevertebralbody,andtheanteriorportionoftheannulusfibrosisThemiddlecolumn(B)consistsoftheposteriorlongitudina
5、lligament,posteriorpartofthevertebralbody,andposteriorportionoftheannulusTheposteriorcolumn(C)consistsofthebonyandligamentousposteriorelementsEvaluationofSpinalInjuryHISTORYMechanismofinjuryCommoncauses:motorvehicleaccidents,falls,divingaccidents,andgunshotwou
6、ndsPHYSICALEXAMINATIONNEUROLOGICALEVALUATIONNEUROLOGICALEVALUATIONSensory,motor,andreflexfunction,isimportantindeterminingprognosisandtreatmentNeurologicexaminationrecommendedbytheAmericanSpinalInjuryAssociation(ASIA)SensoryExaminationDermatomelandmarks---then
7、ippleline(T4),xiphoidprocess(T7),umbilicus(T10),andinguinalregion(T12,L1),aswellastheperineumandperianalregion(S2,S3,andS4)EvidenceofsacralsensorysparingcanestablishthediagnosisofanincompletespinalcordinjuryMotorExaminationTheextremitiesandtrunkSacralmotorspar
8、ing---voluntaryrectalsphincter/toeflexorcontractionsIfvoluntarycontractionofthesacrallyinnervatedmusclesispresent,thentheprognosisforrecoveryofmotorfunctionisgood.screeningexaminat
