Paraplegia

      The following are several causes of paraplegia:

　　1. Paraplegia caused by trauma: Injury to the spinal cord or cauda equina due to spinal fracture or fracture-dislocation, with nerve injury and inability to function normally.

　　2. Paraplegia caused by tuberculosis: There is a history of spinal tuberculosis or symptoms of tuberculosis intoxication, with the lesion occurring mostly in the thoracic or cervical spine. The course is slow, often presenting with spastic paralysis, weakness and rigidity of the limbs or both lower limbs, with posterior or lateral curvature deformity at the affected site, without widening of the spinous process interval. Radiographs show vertebral bodies with osteolytic destruction, narrowing or disappearance of intervertebral spaces, with possible interlocking of vertebral bodies, and shadow of abscess adjacent to the vertebra. Erythrocyte sedimentation rate is accelerated.

　　3. Paraplegia caused by tumors: Commonly seen in vertebral hemangiomas, giant cell tumors of the vertebrae. ① Vertebral hemangioma: Commonly seen in older women, occurring in the thoracic and lumbar segments of single or multiple vertebrae. Early symptoms include local dull pain or band-like pain, sensory abnormalities, and a slow course. X-ray films show the vertebrae with thickened bone in longitudinal arrangement, with interlaced areas of decreased density, appearing as latticelike or multicystic compression. ② Giant cell tumor of the vertebrae: Commonly seen in middle-aged and young adults, with intermittent obscure local pain initially, followed by local tenderness, limited activity leading to paraplegia. X-ray films show the vertebrae with spongy-like shadows or osteolytic changes, with incomplete trabecular structure.

　　4. Paraplegia caused by metastatic tumors: There is a history of primary tumor treatment (uterine cervical cancer, breast cancer, prostate cancer, lung cancer, thyroid cancer, etc.). The symptoms of paraplegia appear gradually and the course is slow. Radiographs show vertebral bodies with osteoporosis, presenting with anterior and posterior consistent compression, with osteolytic or eroded-like destruction, with osteogenic spots and nodular ossification shadows, or with a mixed image of osteogenic and osteolytic types. The intervertebral spaces above and below are generally without significant changes.

　　Paraplegia can lead to bedsores, bedsores (also known as pressure sores, pressure ulcers) are caused by long-term pressure on local tissues, leading to persistent ischemia, hypoxia, and malnutrition, resulting in tissue ulceration and necrosis. Skin bedsores are a common problem in rehabilitation treatment and nursing. According to relevant literature reports, about 60,000 people die each year from complications of bedsores. It has become the number one 'killer' of bedridden patients and should be paid enough attention. It is recommended to use bed sore medicine such as Youshuangning in accordance with physician advice for timely treatment, and at the same time, timely rehabilitation training should be carried out under the guidance of a health manager.

　　1. Motor function, in the case of transverse injury, the motor function below the segment of injury disappears after the period of spinal shock, and muscle tone gradually increases, and reflexes become hyperactive. Some patients may gradually show muscle autonomy after the recovery of the period of spinal shock, but the muscle groups under the jurisdiction of the damaged segment may show relaxation, atrophy, and disappearance of tendinous reflexes.

　　2. Autonomic nervous system dysfunction, such as high fever, anhidrosis, slow intestinal peristalsis, constipation, etc. After the reflex shock period, the reflexes of the paralyzed limb gradually become hyperactive, and muscle tone changes from flaccidity to spasm.

　　3. Spinal shock, which is the complete flaccid paralysis below the segment of injury after spinal cord injury, accompanied by various reflexes, sensory, and sphincter dysfunction clinical phenomena. In mild cases, this manifestation can recover within a few hours or a few days without sequelae.

　　4. Sensory impairment, all sensory functions below the level of injury are lost.

　　For those whose spinal cord function has not been restored, it is necessary to actively strengthen functional training and carry out rehabilitation activities to promote the recovery of paralyzed muscles, prevent adhesions of joints, ligaments, and nearby tendons, and maintain normal joint movement of the limbs.

　　Sports is a good means of rehabilitation, which has a positive effect on promoting the blood circulation and normal metabolism of the whole body and limbs, and restoring the function of the body and limbs. For people with paraplegia, sports have a more important role.

　　One, Under evoked potentials, the somatosensory evoked potentials (SEPs) show a slowing of conduction velocity of the posterior column nerve fibers. The corticospinal tract evoked potential shows a significant decrease in conduction velocity. In comparison, the upper limb evoked potential is normal, or only shows mild slowing of conduction velocity.

　　Two, Electromyography can find denervation changes, but the conduction velocity of peripheral nerves is normal.

　　Three, MRI of the head and MRI of the brain generally show no abnormalities, but some cases may show maldevelopment of the corpus callosum, brain, and small paraplegia. MRI of the cervical or thoracic spinal cord can show spinal cord atrophy.

　　Four, Physical diagnosis examination:

　　Grade 1: The patient walks normally, feels strong in the lower limbs, and examination may show or not show clonus, pathological reflexes of extensor hallucis longus are positive.

　　Grade 2: The patient has muscle tension, spasm, weakness, and uncoordinated movements when walking. Whether with or without crutches, the patient can walk, and examination shows spastic hemiparesis.

　　Grade 3: Lower limb muscle weakness, unable to walk, the patient is forced to lie in bed. Examination shows an extended type of paraplegia, about 50% of cases have sensory disorders.

　　Level 4: Patients present with flexion-type spastic paraplegia, with more than 50% of patients experiencing sensory impairment, often with bedsores, or even more functional disorders of the sphincters.

　　1. Appropriate carbohydrate intake, as excessive carbohydrates lead to excessive calories and increase body fat.

　　2. Choose foods rich in dietary fiber, such as coarse grains, vegetables, fruits, legumes, and other rough foods to promote defecation. Moreover, dietary fiber can shorten the time for food to pass through the intestines, reduce the absorption of cholesterol in the intestines, and is beneficial for lowering cholesterol.

　　3. Provide a high-protein diet, with a protein intake of 1.5-2g/kg body weight per day, with 50% of dietary protein from legumes and animal protein, fish and meat containing about 15-20% protein, eggs containing 11-14%, soybeans containing about 40% protein, and grains containing 7-10% plant protein.

　　4. When eating, arrange the patient to maintain a comfortable sitting position as much as possible, avoid various adverse stimuli; meals should be regular in terms of timing and quality, eat more roughage vegetables, drink more water, and prevent constipation.

　　5. Use more vegetable oils in the diet, such as peanut oil, sesame oil, rapeseed oil, soybean oil, etc. This is conducive to lubricating the intestines and alleviating constipation. Use more fruit juices, fresh fruits, and jams, etc., as these foods contain sugar and organic acids, which are helpful for peristalsis. In addition, honey, raw cucumber, kohlrabi, dried radish, sweet potatoes, and other foods can produce gas and stimulate intestinal peristalsis. If there are no contraindications, sufficient fluid intake should be ensured, at least 2000ml per day, to prevent dry stool.

      1. Conservative Treatment: If the patient's condition is mild and there is hope for the recovery of the spinal cord and nerves, it is best to use some neurotrophic factors to achieve the recovery of nerve function under clear diagnosis, and enhance and improve local blood circulation through traditional Chinese and Western medicine treatment to achieve the recovery of nerve function.

　　2. Surgical Treatment: If the patient's condition is severe and the spinal fracture has seriously injured the spinal cord, surgical treatment should be carried out in a timely manner under clear diagnosis. Surgery can restore the diameter of the spinal canal, allowing nerves to pass smoothly, and create favorable conditions for the recovery of nerve function.