Lumbar fracture

　　Comminuted fracture is mainly formed by the sudden excessive flexion of the spine due to the transmitted force from the head and foot directions, as the spine is injured in the flexion position, the external force is concentrated on the anterior part of a vertebral body, and it is also subjected to compression from the upper and lower vertebral bodies, so the vertebral body is compressed into a wedge shape and moves backward, causing injury to the spinal cord or cauda equina. If it affects the corticospinal lateral tract or anterior tract, spastic paraplegia will occur; if it affects the anterior horn cells of the spinal cord or the cauda equina, flaccid paraplegia will occur. All sensory functions in the lower limbs are lost.

　　1. Spinal cord and nerve root injury is the most serious complication of spinal surgery. It is often seen in incomplete hemostasis during surgery, hematoma compression, or the impact on the spinal cord due to the vibration of operation during decompression; nerve root damage is often caused by instrument stimulation, direct bruising, or excessive traction on the nerve. After surgery, attention should be paid to observe the sensory and motor function of the limbs and the defecation, so as to detect abnormalities in time and report to the doctor for treatment. To reduce edema and improve symptoms, prophylactic intravenous administration of corticosteroids, mannitol, and furosemide, etc., can be used as nerve decompression drugs.

　　2. Cerebrospinal fluid leakage often occurs due to old fractures or severe pre-existing spinal canal stenosis, severe adhesion between the posterior longitudinal ligament and the dural sac, and injury to the dural sac during surgical separation or resection of the posterior longitudinal ligament. Once there is pale blood or meat water-like drainage, and the drainage exceeds 500ml in 24 hours, the negative pressure drainage at the incision should be changed to a general drainage bag immediately, and the patient should lie flat with the head elevated. Postoperatively, strict neck immobilization and local pressure with a 1kg sand bag should be applied. For patients with dizziness and vomiting, the foot of the bed should be elevated 30°-45°, and the head should be lower than the feet. At the same time, report to the doctor and follow the doctor's advice to administer isotonic solution intravenously, and if necessary, suture the incision more densely.

　　3. Early postoperative complications of anterior lumbar surgery include spinal fixation in extension position; autonomic nervous system dysfunction; electrolyte imbalance; or due to the stimulation of the autonomic nervous system by retroperitoneal hematoma, bed rest slows down intestinal peristalsis, and symptoms such as abdominal distension, abdominal pain, constipation often occur. For severe abdominal distension, fasting should be prohibited. After excluding acute abdomen, the abdomen can be warmed, neostigmine injection can be administered intramuscularly, or senna leaves and rhubarb water can be taken orally. If necessary, continuous gastrointestinal decompression and enema can be given. Instruct patients to perform abdominal muscle contraction exercises and inform patients to develop the habit of defecating in bed and defecating at regular times.

　　4. Incision infection often occurs between 3 to 5 days after surgery. The main reasons include poor general condition of the patient, insufficient preoperative preparation, non-strict aseptic operation during surgery, and failure to remove the drainage tube in time after surgery, leading to retrograde infection, etc. The symptoms include fever, increased white blood cell count, local pain, redness, swelling, and purulent secretion from the incision.

　　5. Loosening or breaking of internal fixation in lumbar vertebral fractures, internal fixation in lumbar vertebral fractures is mostly short-segment fixation, which bears high pressure and is prone to cause fatigue bending, loosening, or broken screws, thus affecting the recovery of nerve function and the vertebral body fracture, as well as the appearance of symptoms such as back pain, weakness, and limited activity in the later stage. The main reasons include biological factors, anatomical factors, and factors related to the affected vertebra. Therefore, in addition to the careful operation of the surgeon, patients should be informed that they should not get out of bed too early after surgery, but can perform lumbar and back muscle functional exercises early. After 4 weeks, get out of bed with the help of a brace or after 6 weeks with a lumbar belt, to prevent the failure of internal fixation.

　　1. Local pain, tenderness, and percussion pain.

　　2. Paraspinal muscle tension, limited lumbar movement, and inability to roll over or stand up.

　　3. The spinous process of the injured area may be convex posteriorly or exhibit angular deformity.

　　4. Abdominal distension and abdominal pain are mainly caused by retroperitoneal hematoma due to fractures, which stimulates the autonomic plexus of the abdomen, causing reflex tension or spasm of the abdominal muscles.

　　5. Acute urinary retention is caused by reflex spasm of the bladder sphincter due to stimulation by spinal cord injury or retroperitoneal hematoma.

　　6. Lumbar cord injury may cause compression, contusion, or rupture of the cauda equina, resulting in flaccid paralysis of the lower limbs, loss of sensation, and dysfunctions of the anal and bladder sphincters below the affected level. Injuries to the lumbar sacral spine can cause compression, contusion, or rupture of the cauda equina, presenting as flaccid paralysis of the lower limbs, loss of sensation, and dysfunctions of the perineal sphincters.

　　Avoid injury and pay attention to safety in daily life.

　　1. First aid: If the injured person is still trapped under debris or soil, do not pull the exposed limbs forcibly to prevent further injury to the blood vessels, spinal cord, or fractures. Immediately remove the objects pressing on the injured person. Spinal fractures often accompany fractures of the neck or lumbar vertebrae.

　　2. Use clothing and pillows to compress the sides of the neck and head in the case of a cervical spine fracture, to keep it fixed and immobile.

　　3. If there is a fracture of the thoracic, lumbar, or spinal column, place the injured person on a hard board bed, and stuff pillows, bricks, or clothing on both sides of the body to keep the spine in a straight position. Three people need to work together during transportation: one person supports the shoulders and back, one person supports the waist and buttocks, and one person supports the lower limbs, working in coordination to place the patient in a supine position on a hard board stretcher, with the waist elevated with clothes or bedding.

　　4. Bandage the body wound, flush the wound, and stop bleeding and bandage.

　　5. Complete or incomplete fractures with injury should be fixed on the scene and complications prevented. Special attention should be paid to the fastest way to send the patient to the hospital, and close observation should be made during the transport.

　　(1) In case of suspected spinal fracture and spinal cord injury, first-aid should be provided according to the requirements for spinal fracture immediately.

　　(2) Use hard beds, stretchers, and doorboards for transportation; do not use soft beds. Prohibit one person from carrying the back, and should be carried by 2 to 4 people to prevent exacerbating spinal and spinal cord injuries.

　　(3) During transportation, let the injured person's lower limbs be close together, and the upper limbs be placed against the sides of the waist, and maintain the injured person's posture as a straight line.

　　When transporting patients with chest, lumbar, and abdominal injuries, the waist should be padded with a small pillow or clothing.

　　1. Neurological Examination

　　In addition to the injury itself to the spine, it is necessary to comprehensively examine the function of the spinal cord nerves to determine the level of spinal cord injury. This includes sensory and motor examinations, reflex examinations, and anal examinations.

　　2. Imaging Examination

　　X-ray examination can determine the location and type of fracture. CT examination determines the degree of invasiveness of displaced fracture blocks into the spinal canal and detects bone blocks or intervertebral discs protruding into the spinal canal. Magnetic resonance imaging is extremely valuable for determining the condition of spinal cord injury.

　　The diet of lumbar fracture patients should be light and easy to digest, with an emphasis on eating more vegetables and fruits, a reasonable diet, and ensuring adequate nutrition. In addition, patients should also pay attention to avoiding spicy, greasy, and cold foods. Avoid blind supplementation of calcium, avoid difficult-to-digest foods, and avoid eating too much meat and drinking bone soup.

　　If there are other serious complex injuries, active treatment should be carried out to save the lives of the injured. Then, according to the stability of the spine, conservative treatment and surgical treatment can be adopted.

　　1. Conservative Treatment

　　It is suitable for simple compression fractures with height > 50%, simple spinous or transverse process fractures, stable fractures without nerve injury.

　　2. Surgical Treatment

　　The purpose is to relieve spinal cord nerve compression, correct deformities, and restore spinal stability. It is suitable for unstable spinal fractures, vertebral body compression exceeding more than 1/2, and deformity angles greater than 20°. Methods include posterior pedicle screw fixation, anterior abdominal surgery, and spinal cord nerve decompression surgery. In recent years, some scholars have also adopted percutaneous minimally invasive surgery.