白袍恐懼症

Spine trauma

-cervical spine: most mobile, cervical stability depends greatly on the integrity of the   ligaments that run from level to level

-thoracic spine: least mobile (rib cage -> stabilization)

-lumbar spine: relatively massive vertebrae, supports heavy loads

<Injuries of the Upper Cervical Spine>(C4以上)

1.      Jefferson Fracture (Atlas fractures)

-bursting fracture of C1 (the atlas) due to compression forces

-isolated C1 fractures rarely have associated cord injury.

symptoms  

neck tenderness, need neck support, pharyngeal protuberance, dysphagia 

Treatment choices:

 -The rule of Spence(在 open mouth view): 7 mm or greater combined dislocation indicates disruption of the transverse ligament

 -stable: dislocated <7 mm -> rigid collar

 -unstable: dislocated >7 mm -> halo vest

2.      Odontoid Fractures

about 10-15% of all cervical spine fractures.

In children, these consitute about 75% of all C-spine injuries.

Classification

Clinical Features

-many signs and symptoms are non-specific

-vertebral artery compression may cause brain stem ischemic symptoms.

Surgery  

Type I : no fusion required

Type II : several factors important in decision making

(If >6 mm and >60 years, 85% nonunion rate)

Type III : no fusion required(>90% fuse with Halo immobilization)

3.      Hangman's Fracture

-The Hangman' s fracture is the most common cervical spine fracture.

- extension-fracture

-bilateral C2 pars interarticularis fractures with variable C2 on C3 displacement

Classification

Clinical Features

diffuse neck pain with stiffness

Treatment

-type I may be treated in a rigid collar for 12 weeks.

-remainder are all treated initially with Halo immobilization.

-up to 5% will eventually require surgery.

4.      Atlanto-occipital dislocation

-uncommon injury characterized by complete disruption of all ligaments between occiput and atlas with subluxation or complete dislocation of the occipitoatlantal factes.
-Anterior translation of the skull on the vertebral column is the most common presentation.
-Death usually occurs immediately from stretching of the brainstem, which causes respiratory arrest.

<Three column model>

failure of 2 of the 3 columns implies that there will be instability.

<Thoracolumbar Spine Fractures>

-represent 40% of all spine fractures

-majority due to motor vehicle accidents.

grouped into

      -thoracic (T1-T10)

      -thoracolumbar (T11-L1)

      -lumbar fractures (L2-L5)

-60% occur between T12 and L2

Biomechanics

compression causes burst fractures

flexion causes wedge fractures

rotation causes fracture dislocations

shear causes seatbelt type fractures

Thoracolumbar Compression fracture(壓迫型)

 -most common type of fracture

-failure of the anterior column only due to flexion and compression

-stable, pain, no neurologic deficit

-managed with bedrest, analgesics, and early mobilization

Thoracolumbar Burst Fracture(破裂型)

-17% of major spinal fractures

-pure axial compression -> failure of anterior and middle columns, unstable

- between T1-T10, most burst fractures are associated with complete neurological deficit.

- treated with surgical decompression and fusion.

Thoracolumbar Chance Fracture(Seat Belt Injuries)

-6% of major spinal injuries

-caused by hyperflexion and distraction of the posterior elements.

- failure of the middle and posterior columns

-lap seat-belt hyperflexion with associated abdominal injury is typical

Thoracolumbar Fracture-Dislocation(脫臼型骨折)

-19% of major spinal fractures

-anterior and cranial displacement of the superior vertebral body with failure of all three columns

Treatment by degree

first degree is mechanical instability, second degree is neurolgical, and third is both.

first degree: manage with external orthosis

      i) >30 degree wedge compression fracture

      ii) Seat belt injuries.

second degree: mixed category

third degree: all require surgery

      i) fracture dislocations

      ii) burst fractures who fail non-operative

          management

      iii) burst fractures who develop new

          neurological deficit

參考資料

http://www.ncbi.nlm.nih.gov/books/NBK27231/

http://www.radiologyassistant.nl/en/49021535146c5