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Tashkent medical academy
Traumatology chair and orthopedy, field surgery with
neurosurgery
1
ЛЕКЦИЯ
Chief of the chair
Doctor of medical sciences
Karimov Murod Yuldashevich
2
Injury of the backbone and
hip
3
4
F. Denis
J. Spine 1983.
№ 8.
pp.817-831
5
6
Spine scheme and spinal
cord
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Scheme of segment
innervation
8
Scheme of segment
innervation
9
Scheme of segment
innervation
10
Injury of the backbone belong among
most severe injuries.
They is 0, 4 - 0, 5 % of all fractures of
skeleton bones. A considerable
number of injuries - young peoples.
11
50% closed the injuries of the
backbone are complicated by the
spinal cord injury of different
severity rate. 55, 3% injured is
diagnosed ekstravertebral
damage (Кariev M.X. 1997).
12
At the foundation of spinal cord injury it is
considered devascularization, follow the
pattern seen in ischemia or haemorrhagic
character. High sensitivity of gray matter
to oxygen defect (the blood flow velocity
in gray matter in 4, 5 times higher than
white ) stipulates frequent thick places
defeat of spinal cord.(Коnоvalov А.N.
1994)
13
38, 8% cases they are followed by the
traumatic shock.
The disablement when complicated
by the injuries of the backbone is
95%.
Lethality in that patient population up to 30%.
14
Clinical symptoms and gravity
Injury of the backbone on F. Denis (1982 )
Is determined:
1. Mechanism of damage.
2. Damage area.
(damaged by the column )
3. Stability.
(or instability )
15
In initiation of different injuries of the backbone
separate 5 basic mechanisms traumatic the
action:
1. Flexoral
2. Extensorial
3. Compression
4. Дистракционный
5. Rotary
16
1. When flexoral mechanism the
injury of the backbone occurs due to
of sharp bending body at a point of
fall on buttocks, on rectified feets,
when gravity fall on shoulders injured.
17
Is more frequent region lower
neck and the toracallumbal
department may be accompanied
break above and interossio
binders, intervertebral disk with
and luxation.
18
1. Flexoral mechanism injury of the
backbone
19
2..
The etensorial mechanism
leads to damage front supporting
complex of spine.
Due to of forced straightening
spine front the longitudinal binder
is bursting, damages the
intervertebral disk, may also
appear the roots fracture of
arclets.
20
Extensorial mechanism of damage.
21
3. Compression mechanism injury of the
backbone
When compression mechanism of damage action go
strictly on vertical axis of neurocentrum and
intervertebral disk. This is possible in Shane and
lumbar spines. Damaging the force per saltum bitterly
raises the intradiscal pressure, that leads to damage
of cranial замыкательной plate of body downgradient
vertebrae.
22
Compression
mechanismмеханизм
injury of the
Компрессионный
backbone
повреждения позвоночника
23
In formed the break is introduced
compressed around the bend the
pulposal nucleus of intervertebral disk
and disrupts the neurocentrum on
individual fragments. More often is
available as much as debrises, the
neurocentrum decreases vertically and
increases in anterior-posterior size.
24
Compression fracture
25
II
III
IV
Spine
roentgenography in
sagittal projection.
Compression
fracture 1 degree.
VL3
V
26
III
Same sick, increase
of damage area.
27
III
Same sick, direct
roentgenogram
28
Compression fracture L1 II degree.
29
Compression fracture
L1 III degree.
30
4. Distraction damage is characterized
by the break of back and front
longitudinal binders, fracture back
columns.
31
5. Rotary damage. The mechanism on
spine is acting as creasing, and rotating
the vertebral column of force. Damage
the elements of both supporting
complexes of spine, arises переломовывих or the vertebrae luxation. The data
type damage is common to neck and
lumbar spinal cords.
32
It should be noted that such
division highly escrow, because in
real-life situation damage under
the influence several traumatic
forces is common.
33
Р
Transport immobilization when fractures
Транспортная
иммобилизация
of pectoral of
lumbar spine.при повреждении
позвоночника
34
Fixing of cervical by the cut.
The fixated method has been
shown when damage of
ligamental apparatus; when
body fractures, arclets and
vertebrae shoots without
displacement; when steady
displaced fractures (1
compression degree ), fractures
and dislocations of vertebral
bodies after good singlemoment of closed reduction; in
complement to ekstention and
operational methods.
35
On F. Denis (1982 ) are determined: stability. (or
instability )
To steady damages belong:
Single injury of structure of back
column (above aristate and between
aristate binders, aristate, articular or
spines of vertebra, arclets of
neurocentrum );
36
Compression wedge and blasting
fractures with decrease in the
altitude of neurocentrum less than
on 1/3;
Single injury front, back
longitudinal and connective
intervertebral disk.
37
To volatile
Cerebral compression when
Vertebrae luxation
Luxations and vertebrae
subluxations;
Fracture vertebrae luxations;
38
■ Traumatic spondylolisthesis (gradually
developing against damage ligamental
apparatus bias of neurocentrum to );
Injury from dislocation and from
stretching.
39
40
Blasting fracture with cerebral
compression
41
MRI picture cerebral compression
42
Vertebral prosthesis
43
Roentgenogram
44
Р
Transport immobilization when fractures
Транспортная
иммобилизация
при повреждении
by the huddle
of lumbar spine.
позвоночника
45
Transport
immobilization when
fractures of neck
dept. spine.
46
When uncomplicated the
compression fractures of the
vertebral body of pectoral and
lumbar spinal cords apply function
the treatment.
47
Reduction when fracture of a vertebra in huddle lumbar spinal cord on
universal orthopaedic table based on springed the metal tapes.
of phased reduction.
48
Method
Reduction of compression fracture of pectoral and lumbar
vertebrae on pneumatic reklinator. And - reklinator scheme:
1-3 - air chambers of reklinator, 4- branch pipes for air
injection; б - patient's position on reklinator
49
Thrust axis in
treating by the
extension of
fractures of cervical
vertebrae.
A- flexoral (fleksion;
Б - extensorial
(ekstension.
Extensions by the
skull traction tongs,
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51
Superposition
of plaster
jacket when
fractures of
cervical
vertebrae, the
flexoral
flections
extensorial
ekstensions
52
System of skeletal traction for treatment of
abnormal conditions of cervical of vertebrae
53
Therapeutic physical culture. The
main aim of this technique consists in
creation of natural muscle corset by
the way of special early systematic
exercises, massage of the spinal
muscles and belly.
54
Strengthening of muscle corset back
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Strengthening of muscle corset back
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Exercise to fortify front of muscle group
57
Exercise to fortify front of muscle group
58
Muscle corset
59
Muscle corset
60
Is not sitting, in such regulation!
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The hard bed is recommended
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Occupation by
the exercise
63
Volatile damage
The subluxations, the luxations and the fracture
the vertebrae luxations arise in most moving part
of vertebral column - of Shane department. In
sternum the slipped disc more often leads to
fractures of articular processes. For lumbar
spinal cord the fracture the luxations more are
typical.
64
НЕСТАБИЛЬНЫЕ ПОВРЕЖДЕНИЯ
65
Rate
• Indications for operative treatment is:
• Rise of neurological symptomatology;
• The liquorodynamics bloc (i. e. continuing and
growing the cerebral compression;
• Lack of effect from reduction by conservative
methods;
• Spinal-fusion care
• Volatile damage, in which long-term is stationary
in bed can result in bedsores and other
complications.
• In case of continuing cerebral compression to be
produced its the decompression. When volatile the
injuries of the backbone are being done different
stabilizing operation.
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Spinal-fusion care
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Передняя декомпрессия спинного мозга в шейном отделе по Юмашеву,
а – деформация при переломовывихе; б – резекция фрезой части позвонка;
в – удаление задней компактной пластины тела позвонка;
г – замещение тела позвонка трансплантатом.
68
Surgical treatment
Operation on spine
videofilm
1 Film
2 Film
3 Film
69
Low back Spirit crossover and body
(Mary Walter )
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Pelvic damage
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Injury of pelvic bones
Sick with injury of pelvic bones
is in the range of 5? Up to 10%
all traumatologic sick.
Among the injured with multiple
fractures they is 3, 3%, with
combined by damages - 25, 5%.
74
At every third injured with these damages of Taz
arises the traumatic shock. When multiple and
combined fractures of the pelvis massive bleeding
(up to 2, 5 bloods litres ).
Often the gravity of clinical symptoms is
determined by complications, to which belong
damage of internal organs.
75
76
перелом Мальгеня - перелом
лонной и седалищной костей с
одной стороны и вертикальный
перелом подвздошной кости с этой
же стороны (Рис. 58);
перелом Вуалемье вертикальный перелом крестца
и переднего полукольца таза,
как при переломе Мальгеня, с
той же стороны (Рис. 59);
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перелом Нидерля (диагональный
перелом таза) - вертикальный
перелом подвздошной кости с
одной стороны и переднего
полукольца - с другой (Рис. 60);
перелом Дювернея - перелом
заднего полукольца с
переломом вертлужной
впадины.
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• Clinic and diagnostics
• The diagnostics when fractures of pelvic bones largely adds
together from clearing of mechanism of trauma, pose definition
of sick in moment of injury, inspection injured and Pelvic
palpation. The unconsciousness state of the patient,
conditioned by the shock, internal hemorrhage and eventual
damage of internal organs, hinders the diagnostics. On a
number of occasions of difficulty may be associated with
inaccessibility of some body parts for palpation. On the view of
sick it must be remembered that the hematoma on site of
fracture is seen not at once, sometimes it occurs on body
surface after for several hours or even days after the trauma.
• Is typical the pose injured: foot slightly are bent at knees and
hip joints, are alloted and the outside (the regulation "of frog"
).
• On palpation on available departments of Pelvic (pubic, ischium,
the wing crest of ilium bone ) arises the increased pain.
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• As important symptom when most of fractures of the pelvis is the
violation of supporting ability of limbs. The symptom "of adherent
anvil", as with fractures of proximal femur often is being revealed.
• The extent of the bias of Pelvic when fractures with discontinuity
front and back semiring is determined by measurement of
distance from top of xiphoid appendix up to the front superior
Pelvic spinule or up to apice of one of ankles.
• When fractures of pelvic bone, especially back semiring, are
organized retroperitoneal hematoma, that may to give the clinical
picture of acute abdomen (pseudo the abdominal syndrome ). For
cutback of pain syndrome and differential trouble shooting of
abdomen organs with retroperitoneal hematoma have to do
inside pelvic the anaesthesia on Selivanov. If after anaesthesia
remain the rebound tenderness symptoms, then follows to
suppose the damage of abdomen organs and to produce the
abdominal paracentesis.
80
Important in trouble shooting of
Pelvic is the positive symptom of
Verneul: increased pain in site of
fracture when Pelvic
compression for wings of ilium
bones (fig. A).
When some fractures the
positive symptom Larey is being
revealed: the pain occurs in
deep disposed the hipbones in
an attempt to deploy hipbones
for the front superior spinules
(fig. Б ).
81
First aid and treatment
Few of them may come at the reception to doctor
independently. Sick with breakaway the front superior
Pelvic spinule go by the back forward. This so-called
<symptom of return motion>. Most frequently sick with
these damages do not need extraordinary actions of first
pastime help. Basic method their treatment conservative: produce the anaesthesia of site of fracture
and sick stack on hard (with wood the shield ) the bed at
the position <frog>. The bed rest remains during 4-6
weeks. Within this period designate the therapeutic
physical culture and ФТЛ - procedure for faster
reestablishment of motor activity. Employability is being
restored after 8-10 weeks.
82
Sick 3 - 6 groups as they enters in the specialized
permanent establishment almost always demand high
priority measures of pastime help, which most frequently
are held in resuscitation department.
The salvage service of this group injured is to be begun
with conducting against shock therapy and stoppage
internal hemorrhage by available means. To such events
belongs inside the pelvic block on Selevanov when
fractures back Pelvic semiring (the novocaine is inserted
into the fascial space of m. Iliopsoas, which is being
fastened to have twirled of hip ).
83
• After extraction of sick from shock and
replacement of blood loss begins treatment by
the method of constant the skeletal traction for
supracondylar region of hip on the side damage
when fractures.
84
Sick with fracture of the symphisis pubis,
sacroiliac joint are being treated in hammock
up to 6 weeks.
Operative therapy has been shown when
avulsion fractures and unsuccessful
conservative treatment of symphysis
fractures and basin. In recent years indication
to operative therapy of fractures of the pelvis
is considerably expanded.
85
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87
Fractures of pelvic bones with damages of pelvic bodies
When fractures of pelvic bone may deteriorate bodies,
located in small pelvis - the bladder, the urethra, the rectal
intestine, extremely seldom the vagina, the uterus and the
appendages. Most frequently are seen urethral injury and
bladder. Damage of urinary organs accompany fractures of
pelvic bones in 10-28% in adults and in 7-8% in childrens.
Differentiate extra- and the intraabdominal ruptures of the
urinary bladder. The extraperitoneal breaks more often
come due to of change of configuration of pelvic ring and
sharp tension binders, which fix the bubble. Rarer the
bladder are wounding debrises of pelvic bones.
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Against shocked device
Ghana in case of
violation of pelvic ring
105
Protect spine
106
Lethality
107
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