Tashkent medical academy Traumatology chair and orthopedy field

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

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F. Denis J. Spine 1983. № 8. pp. 817 -831 5

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Spine scheme and spinal cord 7

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. 2. 3. 4. 5. Flexoral Extensorial Compression Дистракционный 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 mechanism injury of the Компрессионный backbone механизм 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 IV Spine roentgenography in sagittal projection. Compression fracture 1 degree. VL 3 V 26

III Same sick, increase of damage area. 27

III Same sick, direct roentgenogram 28

Compression fracture L 1 II degree. 29

Compression fracture L 1 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 of Транспортная иммобилизация 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 single-moment 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

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Blasting fracture with cerebral compression 41

MRI picture cerebral compression 42

Vertebral prosthesis 43

Roentgenogram 44

Р Transport immobilization when fractures by Транспортная the huddle ofиммобилизация lumbar spine. при повреждении 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, 50

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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 55

Strengthening of muscle corset back 56

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! 61

The hard bed is recommended 62

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

• 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. 66

Spinal fusion care 67

Surgical treatment Operation on spine videofilm 1 Film 2 Film 3 Film 69

Low back Spirit crossover and body (Mary Walter ) 70

Pelvic damage 71

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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

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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. 79

• 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 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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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. 88

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Against shocked device Ghana in case of violation of pelvic ring 105

Protect spine 106

Lethality 107