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Abstract Female, 85 y.o., weighting 60 kg, multiple trauma patient. After an initial laparotomy, an emergent thoracotomy was performed using a bronchial blocker for lung isolation (initial active suction was applied). During surgery, bronchial cuff was deflated, causing a self-limited tracheal blood flooding. A second lung isolation was attempted but it was not as effective as initially. Probably, a lung collapse with the same bronchial blocker was impaired in the second attempt because of the obstruction of bronchial blocker lumen by intraoperative endobronchial hemorrhage. Bronchial blocker active suction may contribute to obtain or accelerate lung collapse, particularly in patients that do not tolerate ventilator disconnection technique or lung surgical compression. The use of bronchial blockers technology was a valuable alternative to double lumen tubes in this case of emergent thoracotomy in the context of a patient having thoracic, abdominal trauma, severe laceration of tongue and apophysis odontoid fracture associated to massive hemorrhage, despite several pitfalls that could compromise its use. The authors intend to discuss the advantages and disadvantages of bronchial blockers comparing to double-lumen tubes for lung isolation, and the risks of our approach, in this complex multitrauma case.
Resumo Paciente do sexo feminino, 85 anos, 60 kg, com trauma múltiplo. Após uma laparotomia inicial, uma toracotomia de emergência foi feita com um bloqueador brônquico para isolamento pulmonar (sucção inicial ativa foi aplicada). Durante a cirurgia, o balonete brônquico foi desinflado, causou um derrame hemorrágico traqueal autolimitado. Reisolamento foi tentado, mas não foi tão eficaz como inicialmente. Provavelmente, o colapso do pulmão com o mesmo bloqueador brônquico foi prejudicado na segunda tentativa devido à obstrução do lúmen do bloqueador brônquico pela hemorragia endobrônquica intraoperatória. A sucção ativa do bloqueador brônquico pode contribuir para obter ou acelerar o colapso pulmonar, particularmente em pacientes que não toleram a técnica de desconexão do ventilador ou a compressão cirúrgica pulmonar. O uso da tecnologia de bloqueadores brônquicos foi uma opção valiosa para os tubos de duplo lúmen neste caso de toracotomia de emergência em paciente com trauma torácico e abdominal, laceração grave da língua e fratura da apófise odontoide associados a hemorragia maciça, apesar de vários riscos que poderiam comprometer seu uso. Os autores pretendem discutir as vantagens e desvantagens dos bloqueadores brônquicos em comparação com os tubos de duplo lúmen para isolamento pulmonar e quais foram os riscos de nossa abordagem neste complexo caso de múltiplo trauma.
Subject(s)
Humans , Female , Aged, 80 and over , Thoracic Injuries , Thoracotomy/instrumentation , One-Lung Ventilation/methods , Respiratory Protective DevicesABSTRACT
Ankylosing spinal disorders (ASD) tend to result in fractures and/or dislocations after minor trauma because of the altered biomechanical properties. The relative risk of traumatic vertebral fractures in patients with ankylosing spondylitis has been estimated as three times higher than in the general population. These spine traumas, which are located at cervical level in 81% of patients with ankylosing spondylitis, are complicated by neurological lesions in 65% of patients, due to the high inherent instability of these fractures. Traditional massage is an ancient practice in many parts of Asia. It has many benefits that are currently recognized world-wide. However, it can be dangerous and even lethal if practised without adequate knowledge and skill. We report a case of C6-C7 fracture-dislocation with complete neurology and neurogenic shock in a middle aged man with undiagnosed ankylosing spondylitis.
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Objective To compare the effect and safety between lightwand and general-laryngo-scope application of trachea cannula in cervical spine fracture patients undergoing general anesthesia. Methods Forty cervical spine fracture patients with tracheal intubation anesthesia were selected,including twenty-eight males and twelve females,aged 18-65 years,ASA physical statusⅡor Ⅲ.These patients were randomly divided into two groups,twenty cases in each group.After anesthesia induction,group L was giv-en general laryngoscope intubation,whereas group C was taken lightwand guided tracheal intubation.The success case of intubation at first,intubation time,adverse reaction of intubation,changes of MAP and HR at intubation and 5 minutes after intubation were observed.Results Compared with group L,success rate of intubation at first was higher (90% vs.60%),intubation time was shorter [(31.3±11.1)s vs.(46.6 ±15.2)s]in group C (P <0.05).The changes of MAP and HR were more stable during intubation in group C compared with group L.Four cases of arrhythmia (20%)occurred in group C,while none in group L.Conclusion Compared with intubation by general laryngoscope,application of tracheal intubation led by lightwand in cervical fracture patients is more effective and safer.
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Objective To investigate the effect and perioperative nursing experience of surgical operation on patients with incomplete cervical spinal cord injury caused by traumatic cervical spine fracture. Method Fifty-nine patients with traumatic cervical spine fracture in our hospital from January 2011 to 2014 were nursed perioperatively, including before operation , training accttenty with swallowing and blowing balloons besides basic nursing care , and after operation , mental care , close observation and functional exercises postoperatively. Results The operation time was (110.5+13.0) min, the amount of bleeding was (155.6+7.5)mL. Three patients developed hematoma compression, 13 patients developed high fever. All patients were cured after treatment and nursing. Conclusion Preoperative training of swallowing and blowing balloon is fundamental for ensured surgical effect and intraoperative surgical cooperation and close observation together with postoperative mental care, close obsersation and functional exercise are the guarantee for surgical effect.
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Objective To explore the effect of family cohesion and adaptability on coping with fatigue in patients suffered high paraplegia caused by cervical spine fracture.Methods 96 patients suffered high paraplegia caused by cervical spine fracture were questionnaired by family cohesion and adaptability scale and bricf fatiguc assessment scale after 1 week of operation.And they were divided into the fatigue group and non-fatigue group,the scores of family cohesion and adaptability were compared between the two groups,and thepearson correlation analysis and multivariate linear regression analysis were used to explore the effect of family cohesion and adaptability on coping with fatigue.Results ①65.63％ (63/96) patients suffered coping with fatigue in high paraplegia patients caused by cervical spine fracture.②The scores of teal family cohesion and real family adaptability in the fatigue group were significantly lower than those in the non-fatigue group(P＜0.05) ; the scores of dissatisfaction of family cohesion and dissatisfaction of family adaptability in the fatigue group were significantly higher than those in the non-fatigue group(t=-2.630,-3.359,10.469,17.821,P＜ 0.05).③Pearson correlation analysis showed that the score of coping with fatigue was negatively correlated with the real family cohesion(r=-0.463,P=0.015) and real family adaptability(r=-0.486,P=0.021),and positively correlated with the score of dissatisfaction of family cohesion (r=0.395,P=0.036) and dissatisfaction of family adaptability (r=0.524,P=0.020).④Multivariate linear regression analysis showed that the real family cohesion,real family adaptability,dissatisfaction of family cohesion and dissatisfaction of family adaptability were the influencing factors of coping with fatigue in patients suffered high paraplegia caused by cervical spine fracture.Conclusions Family cohesion and adaptability was correlated with the coping with fatigue in patients suffered high paraplegia caused by cervical spine fracture.
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STUDY DESIGN: A retrospective study. OBJECTIVES: This study was performed by probing vertebral artery injuries and their radiologic characteristics in cervical spine fractures, and analyzing MRI findings of vascular injuries. SUMMARY OF LITERATURE REVIEW: Vertebral artery injuries are found relatively often in cervical spine fractures. MATERIALS AND METHODS: We evaluated 57 cases of cervical spine fractures that occurred beginning in June 2011 and ending in February 2003. The characteristics of each fracture were evaluated using conventional radiographs, CT, and MRI. The presence of a vertebral artery injury was based on the absence of signal void in multilevel transverse foramens. RESULTS: Twelve out of the 57 cases (21.1%) were found to have unilateral vertebral artery injuries. Clinically, impairment in cerebral circulation was not found. We found no statistical correlation between the signal change in the spinal cord and in the vertebral artery injury (P=0.424). We noted fractures of transverse processes in 7 cases, 6 of which showed vertebral artery injuries. Thus, the transverse process facture was associated with t vertebral artery injury (P=0.000). There seemed to be no relationship between the vertebral artery injury and each of following: fracture level (P=0.416), fracture type (P=0.723) and severity of soft tissue injury (P=0.195). CONCLUSIONS: Unilateral vertebral artery injuries were frequently found in the cervical spine fractures. And of all radiographic factors associated with vertebral artery injury, only the presence of transverse process fracture was statistically significant. Absence of signal void at multi-section MR images is considered to be a useful guide to commence additional vascular evaluation.
Subject(s)
Retrospective Studies , Soft Tissue Injuries , Spinal Cord , Spine , Vascular System Injuries , Vertebral ArteryABSTRACT
PURPOSE: Missing cervical pathology after injury may lead to disability and influence long-term survival. Controversies continue to evolve concerning the initial screening methods used to predict cervical spine injury. Through a retrospective chart review, we attempted to analyze and propose factors predictive of cervical trauma. METHODS: Of all the patients who had visited the Emergency Department of Korea University, from January 2009 to December 2009, a retrospective review of the clinical records of the 217 patients who had undergone cervical spine computed tomography was done. We investigated whether we could predict the need for cervical spine computed tomography shortly after presentation in trauma patients by comparing the group with fractures and group without fractures and by finding risk factors showing significant differences between the two groups that might be used as guides in decision making. RESULTS: Of the 217 subjects who underwent cervical spine computed tomography scans, 33 were identified with fractures of the cervical spine while 184 were not. The most common mechanisms of trauma, in order, for those with fractures were falls, followed by traffic accidents. We found that the injury severity score, multiple injuries, a high-energy injury mechanism, neurologic deficit, and pain and tenderness of the cervical spine showed statistically significant differences between the two groups. CONCLUSION: Fractures of the cervical spine that are not observed with simple radiography occur with a relatively high frequency in trauma patients. Consideration should be given to the risk factors for cervical spine fracture, and if pertinent, cervical spine computed tomography should be performed with speed for early diagnosis of cervical spine fractures.
Subject(s)
Humans , Accidents, Traffic , Early Diagnosis , Emergencies , Injury Severity Score , Korea , Mass Screening , Multiple Trauma , Neurologic Manifestations , Retrospective Studies , Risk Factors , SpineABSTRACT
The management of lower cervical fractures in patients with ankylosing spondylitis (AS) differs from normal cervical fractures. Patients with AS are highly susceptible to extensive neurologic injuries and spinal deformities after cervical fractures from even minor traumatic forces. These injuries are uniquely complex, require careful imaging assessment, and aggressive surgical management to optimize spinal stability and functional outcomes.
Subject(s)
Humans , Congenital Abnormalities , Spine , Spondylitis, AnkylosingABSTRACT
@# 3 cases with esophageal fistula following anterior cervical fixation were reported. The diagnosis, treatment, nursing and prevention were summarized with literature.
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[Objective]To evaluate the indications,efficacy and safety of posterior total laminectomy decompression and reduction with pedicle screws for lower cervical fracture and dislocation.[Method]From June 2005 to February 2008,41 patients with lower cervical fracture and dislocation received posterior total laminectomy decompression and reduction with pedicle screws.The patients(M=32,F=9)were 22-47 years old,with an average of 33.5 years old.There were 38 fresh and 3 old injuries.[Result]All the patients were operated on successfully without severe complications during perioperative period.Totally 252 (89%) screws were exactly implanted in the cervical pedicle.The everage surgery time was 3.1 h (2.5-4 h).The average blood loss during the operation was 460 ml (250-950 ml). The average time of follow-up was 27.5 months(24-36 months). All patients had satisfiactory reduction and no internal fixator failure.Thirty-two patients who were followed up for more than 24 months had complete fusion. The motor and sensory score (ASIA92) were improved significantly at 2 years follow-up(P
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Bilateral traumatic abducens nerve palsy is a rare condition. We report a case associated with Hangman's fracture without skull fracture. Seventeen cases of bilateral traumatic nerve palsy were found in the literature and only four cases had bilateral traumatic abducens nerve palsy associated with cervical spine fracture without skull fracture. In case of head and neck injury, the abducens nerve may be damaged at the point of fixation to the dura mater. The pathogenesis, the clinical conditions and the radiological findings are presented.
Subject(s)
Abducens Nerve Diseases , Abducens Nerve , Dura Mater , Head , Neck Injuries , Paralysis , Skull Fractures , SpineABSTRACT
PURPOSE: To evaluate the degree of injury of the spinal cord in relation with the space available for the spinal cord at the level of injury, the sagittal diameter of the spinal canal at the uninjured levels, and the Pavlov ratio at the uninjured levels in fractures and dislocations of the lower cervical spine. MATERIALS AND METHODS: We retrospectively reviewed the records and radiographs of patients who had sustained an acute fracture or dislocation of the cervical spine from 1990 to 1995. We collected patients from Orthopedic and Neurosurgical department of Chonbuk University Hospital and at Orthopedic department of Presbyterian Medical Center. Of the 69 patients analyzed, twelve had no neurological deficit, eleven had an isolated nerve-root injury, twenty-two had an incomplete injury of the spinal cord, and twenty-four had a complete injury. We measured above three parameters from the plain lateral radiographs and assessed the difference by one-way ANOVA and unpaired t-test. RESULTS: 1. The mean space available for the spinal cord at the level of injury was 12.9 millimeter for the complete injury of the spinal cord,13.8 millimeter for the incomplete injury, 14.7 millimeter for an isolated nerve-root injury, and 15.7 millimeter for no neurological deficit group. The overall difference among the groups was significant (F=6.98, P=0.0004). The patients who had a complete injury of the spinal cord and those who had an incomplete injury of the spinal cord were significantly different from the patients who had an isolated nerve-root injury and those who had no neurologic deficit (P=0.002). 2. The mean sagittal diameter of the canal at the proximal and distal uninjured level was 14.3 and 14.6 millimeter for the complete injury of the spinal cord, 14.9 and 14.9 millimeter for the incomplete injury, 15.5 and 16.6 millimeter for an isolated nerve-root injury, and 16.9 and 16.5 millimeter for no neurological deficit group. The patients who had a complete injury of the spinal cord and those who had an incomplete injury of the spinal cord were significantly different from the patients who had an isolated nerve-root injury and those who had no neurologic deficit (P=0.001). 3. The mean Pavlov ratio at the proximal and distal uninjured level was 0.90 and 0.86 for no neurologic deficit group, 0.85 and 0.87 for an isolated nerve-root injury, 0.76 and 0.75 for the incomplete injury of the spinal cord, and 0.76 and 0.76 for the complete injury. The patients who had a complete injury of the spinal cord and those who had an incomplete injury of the spinal cord were significantly different from the patients who had an isolated nerve-root injury and those who had no neurologic deficit (P=0.001). CONCLUSIONS: The patients who sustained a permanent injury of the cord usually had had a narrower sagittal diameter (<14mm) and a lower Pavlov ratio (<0.80) of the spinal canal before injury. Patients who had a large sagittal diameter of the canal may be more likely to be spared a permanent injury of the spinal cord following a fracture or dislocation of the cervical spine compared with patients who have a narrow canal. These findings demonstrated that the severity of the injury of the spinal cord was in part associated with the space available for the cord (at risk:<13mm) after the injury, as measured on plain lateral radiographs.
Subject(s)
Humans , Joint Dislocations , Neurologic Manifestations , Orthopedics , Protestantism , Retrospective Studies , Spinal Canal , Spinal Cord , SpineABSTRACT
To evaluate the neurologic and functional improvement of anterior decompression and fusion in patients with cervical spin injury, the clinical records and x-rays of 17 patients who were treated at Gyeong-Sang National University Hospital between January 1989 and December 1993 were analyzed. The results were as follows 1. There were complete injuries of the cord in six cases, incomplete injuries in nine and nerve root injuries in two. All the patients were treated using anterior decompression and autogenous iliac bone graft with cervical plate fixation within 7 days after trauma. 2. The average time lapse from the operation to radiological union was 9.2 weeks(range;7–14 weeks). 3. The prognosis for neurologic recovery mainly depends on the severity of the initial neurologic status. The recoveries of neurologic deficit were complete in four cases, partial in ten and none in three. The motor index improved from 45.6 to 64.6 and the modified Barthel index was 71.2 points at the last follow-up. 4. The clinical results were excellent in nine cases, good in three, fair in two and poor in three. In conclusion, anterior decompression and fusion with bone graft and cervical plate provided early mobilization and rehabilitation, and improved neurological function in a considerable portion of the patient who had neurologic deficits after cervical spine injuries.
Subject(s)
Humans , Decompression , Early Ambulation , Follow-Up Studies , Neurologic Manifestations , Prognosis , Rehabilitation , Spine , TransplantsABSTRACT
Treatment of unstable cervical spine fracture by skull traction is time consuming procedure, and treatment by Halo appratus has many advantages but it is very expensive. Bone cement has been applied occasionally as an adjunct to metallic internal fixation in treating patient with malignancy, i.e. limited life expectancy. Internal fixation with bone cement in addition to routine posterior fusion with bone graft is tried eliminate the need of application of complicated external immobilization in treating unstable cervical spine fracture of young patient. We experienced two cases of posterior cervical fusion using bone cement with satisfactory results. The advantages of this method are: 1. Rapid and solid fixation 2. Early ambulation 3. Reduce complicated external support 4. Reduce the date of hospitalization.
Subject(s)
Humans , Early Ambulation , Hospitalization , Immobilization , Life Expectancy , Methods , Osteotomy , Skull , Spine , Traction , TransplantsABSTRACT
Cervical spine injuries are increasing recently due to increasing traffic accidents. Many patients have been treated with cervical laminectomy but stabilization of the cervical spine has been neglected as a part of the treatment. 30 patients with cervical spine injuries who were admitted to our hospital from January 1, 1973 to December 31, 1978 were evaluated. The following observations were made: 1. The ratio between male and female was 2:1 and the majority(43%) were found in the 4th decades. 2. The common causes of cervical spine injuries were traffic accident(40%) and falls(33.3%). The most common site of the lesion was the 5th and 6th cervical spine level (33.3%). 3. Among 30 cases, 10 cases(33.3%) had complete paralysis, 12 cases(40%) incomplete paralysis, 6 cases (20%) had nerve root injury and no neurological change is 2 cases. 4. The mechanisms of cervical injuries were classified morphologically and flexion-rotation injuries (55.5%) were the most common. 5. We evaluated the results of treatment neurological & radiographically. In complete paralysis, there was no neurological improvement and cervical kyphosis increased after laminectomy. In incomplete paralysis and nerve root injury, anterior fusion showed slight neurological recovery but mild cevical kyphosis and displacement of the graft were observed. In posterior fusion or cast immobilization, we had a satisfactory result with a high fusion rate and normal cervical curvature. 6. lt is impossible to compare anterior interbody fusion with posterior fusion for neurological recovery. For early mobilization and rehabilitation, we emphasize early stabilization by anterior or posterior fusion according to the mechanism of injury.