Spinal fractures concern to group of heavy injuries of a skeleton and make 2-2,5% of total number of changes. The combination of spinal fractures to injury of the ligaments located in close proximity, muscles, intervertebral disks, backs, a spinal cord is possible. The clinical picture of spinal fractures depends on their arrangement and on whether they are followed by injury of a spinal cord. Changes in the top cervical department of a backbone as traumatizing a spinal cord in this department leads to shutdown of regulation of vital functions of an organism are most life-threatening. Diagnosis of spinal fractures includes a radiological research, backbone KT and MPT, an elektroneyrografiya and so forth.
Spinal fractures concern to group of heavy injuries of a skeleton and make 2-2,5% of total number of changes. The combination of spinal fractures to injury of the ligaments located in close proximity, muscles, intervertebral disks, backs, a spinal cord is possible.
Backbone – a support and the main part of a skeleton. It consists of separate bones (vertebras) which connect by means of continuous and preryvny connections. Between each two next vertebras the elastic intervertebral disks which are carrying out a role of shock-absorbers at static (standing) and dynamic (walking, run, jumps) loadings are located. The basis of a spine column is made by massive bodies of vertebras. Behind the vertebra arch having the half ring form departs from each body. In space between a body and an arch of a vertebra there is a spinal cord. On each arch of a vertebra there are seven shoots (four articulate, two cross and one awned).
Articulate shoots of the next vertebras connect, forming joints. Besides, bodies, arches and shoots of vertebras are connected by the sheaves giving to a spine column the necessary durability and stability. Between two next vertebras there are openings for an exit of backs of spinal nerves. In a backbone allocate 5 departments. The cervical department consists of 7 vertebras, chest – from 12, lumbar – from 5, sacral – from 5 (in this department vertebras are spliced in a uniform bone – a sacrum), coccygeal – of 5 vertebras.
Most often falling from height (on the head, legs or buttocks) becomes the reason of spinal fracture. In developing of fractures cervical department of a backbone the large role is played by the inertial mechanism of a trauma (a so-called "hlystovy trauma") most of which often arises at motor transportation incidents: the car sharply stops, the case of the person is kept by a seat belt, at the same time the head by inertia continues to move forward. As a result the neck is sharply bent, and vertebras are crushed. Sometimes the similar trauma becomes the reason of a fracture of chest vertebras. Besides, spinal fractures can arise at a sdavleniye and a direct trauma (blow in a neck or a back).
All spinal fractures are subdivided into fractures of vertebras without injury of a spinal cord and with its damage (a vertebral and spinal trauma). Also spinal fractures can be combined with damage of intervertebral disks and nervous backs. Allocate the isolated spinal fractures at which there is an injury of one vertebra and multiple, at which the fracture of two and more vertebras is observed. At multiple fractures injury of the adjacent vertebras or vertebras which are at various levels of a backbone is possible.
Distinguish stable and unstable spinal fractures. At unstable changes simultaneous damage of forward and back departments of a vertebra as a result of which there is possible a backbone shift is observed. At a stable change either back, or forward departments of a vertebra therefore the spine column keeps the stability suffer. According to domestic traumatology compression spinal fractures at which as a result of squeezing vertebra body height decreases are more often observed. Less often splintered fractures of vertebras meet.
Changes of cervical department
The structure of I and II cervical vertebras differs from a structure of other vertebras therefore their changes have some distinctive features.
Fractures of the first cervical vertebra
The first cervical vertebra carries the name of the Atlas, has the ring-shaped form, settles down between an occipital bone and other vertebras. Between an occipital bone and the Atlas there is no intervertebral disk therefore pressure from a cranium is transferred to the I cervical vertebra without depreciation. As a result of falling on the head the occipital bone is pressed into a ring of the Atlas and there is Jefferson's change ("the bursting change") at which integrity of a forward and back arch of the I cervical vertebra is broken.
The patient with a fracture of the I cervical vertebra shows complaints to pain in a nape, parietal area and the top part of a neck. In every second case the fracture of the I cervical vertebra is followed by damage of back, is more rare – a medulla or a fracture of other vertebras. Injury of a spinal cord is demonstrated by violation of sensitivity and motive function of the top and lower extremities (a tetraplegiya or tetraparesis). Injury of a medulla is fraught with violation of the major vital signs (breath, heartbeat).
Fractures of the second cervical vertebra
The second cervical vertebra (an axial vertebra or ) has the ring form. In a forward part of an aksis the massive bone ledge (tooth of an aksis) on which the first cervical vertebra is fixed is located. Sharp bending of a neck leads to the fact that the Atlas is excessively displaced back or forward and breaks tooth of an aksis. The condition of the patient depends on degree of shift of a bone fragment of tooth. At a fracture of the second cervical vertebra of the I degree shift on roentgenograms does not come to light. The patient shows complaints to unsharp pains at turns of the head.
At fractures of the second cervical vertebra of the II degree tooth it is displaced kpered or kzad. Shift of a fragment of a kpereda can cause neurologic violations of different degree of expressiveness: from local violations of sensitivity to paresis and paralyzes. At the shift of tooth of a kzada neurologic violations are, as a rule, less expressed. Fractures of the second cervical vertebra of the III degree cause heavy injuries of a spinal cord and are, as a rule, incompatible with life.
Traumatic II cervical vertebra
Spondilolistez is called the shift of an overlying vertebra in relation to underlying. The vertebra can be displaced back, forward or sideways. Such trauma arises at sharp extension of a neck in combination with blow of the head against an obstacle (for example, at a car accident when the body of the passenger is displaced kpered, and it hits the head against a windshield).
Usually such trauma is resulted by a change of an arch of the II cervical vertebra in a combination to the shift of his body of a kpereda. The victim is disturbed by the neck pains and areas of a nape amplifying at the movements. A characteristic symptom is the compelled position of the head: the patient as though "bears" the head, at the same time quite often supporting her by hands.
Fractures of the III-VII cervical vertebras
As a rule, such spinal fractures are result of sharp bending of a neck. Most often there are compression fractures of cervical vertebras, is more rare – splintered. At uncomplicated changes the patient shows complaints to pain and restriction of movements in a neck. If the fracture of a vertebra is followed by a rupture of sheaves, there is a threat of injury of a spinal cord.
Diagnosis of fractures of cervical vertebras
For confirmation of a fracture of the first cervical vertebra carry out roentgenograms in special projections (pictures do through a mouth). In certain cases carry in addition out backbone KT. At suspicion of fractures of other cervical vertebras the X-ray analysis in perednezadny and side projections is made.
First aid at changes of cervical department of a backbone
At suspicion of such fracture it is necessary to consider that the sharp movements can cause the shift of otlomk and injury of a spinal cord therefore it is necessary to work extremely carefully and accurately. The patient is stacked on a back on a stretcher. The neck is fixed a special collar. The head of the victim cannot be pulled or turned.
Treatment of changes of cervical department of a backbone
At the neoput spinal fractures impose Shants's collar or a plaster corset for up to 4 months. At threat of shift of otlomk carry out extension by Gleason's loop or hardware extension for a skull for up to 1 month then carry out an immobilization a rigid collar for a period of up to 4 months. At heavy damages make the fixing operations with use of plates, laminar counteractors and transarticulary clamps.
Fractures of chest and lumbar vertebras
Compression spinal fractures
The most widespread kind of spinal fractures. The vertebra sdavleniye (results at a jump from height, falling on buttocks). It is characterized by reduction of height of a vertebra. Compression changes of XI, the XII chest and the I lumbar vertebra are most often observed.
The risk of developing of compression spinal fracture increases at osteoporosis. Almost at a half of women 80 years on roentgenograms are aged more senior symptoms of an old compression fracture of vertebras come to light. At the same time patients are injured during insignificant falling and often do not address the traumatologist, including back pains a sign of age changes.
Pathological compression spinal fractures quite often arise at metastasis of malignant tumors when the vertebra destroyed by a metastasis breaks as a result of the minimum trauma.
Splintered spinal fractures
Are observed less often. The heaviest type of splintered spinal fracture – an explosive change at which there is a splitting of a body of a vertebra on several fragments. As a rule, such changes are a consequence of falling from the considerable height, a production or road trauma.
Symptoms of spinal fractures
At uncomplicated spinal fracture (without injury of a spinal cord) the patient shows complaints to the pain in a back amplifying at the movements of the case. Visually smoothing of contours of a back furrow, insignificant hypostasis or some camber in the field of damage is sometimes observed. Pains can amplify at deep breath or cough. Occasionally at spinal fractures the irradiation of pains in a stomach feigning a picture of "a sharp stomach" is observed.
The palpation of awned shoots is painful, expansion or narrowing of an interval between them sometimes is defined. A characteristic symptom of spinal fracture – pain in the place of a change at careful pressing on the patient's head. Independently this sign should not be checked as excessive pressure at an unstable fracture of vertebras can become the reason of shift of otlomk.
Violations of movements, sensitivity or function of pelvic bodies demonstrate injury of a spinal cord. Splintered fractures of vertebras become the reason of such violation usually and it is rather rare – the heavy compression spinal fractures which are followed by considerable decrease in height of a vertebra.
Complications at spinal fractures
Compression spinal fractures with reduction of height of a vertebra by 50% and more in the subsequent can be complicated by excessive mobility (segmentary instability) which is shown by persistent pains, bystry development of degenerate changes and damage of nervous structures.
At elderly patients emergence of "a senile hump" - characteristic deformation of a backbone which is also followed by chronic pains is possible.
The heaviest complication is the gap or a sdavleniye of backs or a spinal cord. Ruptures of nervous structures are shown at the time of a trauma. Sdavleniye can arise both at the time of damage, and in the remote period. In the latter case neurologic violations are more often caused by squeezing of blood vessels and the subsequent violation of food of a spinal cord. Narrowing of the vertebral channel leads to a compression miyelopatiya – to the progressing neurologic violations which can be stopped only by means of operation.
The diagnosis is confirmed by results of a X-ray analysis in a perednezadny and side projection. At suspicion of unstable spinal fracture carry out CT (computer tomography) which allows to see both fractures of bones, and damages of myagkotkanny structures. For diagnostics of damages of backs and a spinal cord use backbone MRT.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
At uncomplicated compression changes conservative therapy is shown: anesthesia in combination with the fixing devices (corsets, reklinator) and the special mode. The patient is stacked on a board with the roller under the field of damage. Within 12-14 weeks forbid to lift weights, to sit, bend forward and to sharply turn a trunk. In some cases impose a plaster corset for up to 6 months.
The physiotherapy exercises are of great importance. The developed muscles of a back "undertake" a part of loading, unloading, thus, vertebras and promoting their good union. At unstable spinal fractures, a sdavleniye of nervous backs and a spinal cord backbone operations are performed. For stabilization of vertebras use various clamps, and at impossibility of restoration of vertebras apply implants from artificial materials.