Examination guidance for Chinese medicine practitioners: treatment of spinal fracture and dislocation

1. Reduction

Flexion spine fracture: it is the most common vertebral compression fracture.

① Double-ankle suspension method: The patient lies prone, and the ankles are lined with cotton pads and tied with ropes, then the feet are slowly lifted so that the body forms an angle of about 45 with the bed surface [as shown in the figure ].

The operator can press the affected part with the palm of his hand properly to correct kyphosis, and this method can give painkillers or local anesthesia before reduction. After reduction, the patient lay on his back on a hard bed and the fracture was cushioned.

② climbing rope and stacking bricks: this method is a reduction method of overstretched spinal fracture. The shilling patient climbs the rope with both hands, with six bricks, and three bricks are stacked on the left and right sides respectively. Step on the bricks with both feet, and then remove the bricks under the feet, so that the body is suspended (the toes touch the ground) and the spine is hyperextended. The doctor stands behind the patient's waist and corrects the kyphosis. It is suitable for patients with simple thoracolumbar compression fracture with strong physique and flexion.

③ Cushion method: When using this method, the patient should lie on his back on a hard bed, and a soft pillow should be placed at the fracture part, which can be gradually increased to make the spine overstretch.

this method is more effective if it is combined with acrobatic therapy. It is suitable for flexion-type simple thoracolumbar compression fracture and maintaining the reduction effect after hyperextension reduction.

④ door-climbing and stretching method: this method is to make the patient prone on the hard bed, with both hands clinging to the upper edge of the board, with three people pulling and stretching at the lower waist and lower limbs, and the doctor pressing the fracture with both hands for reduction. This is a non-hyperextension spinal fracture reduction method, which is suitable for unstable flexion thoracolumbar compression or comminuted fractures and elderly patients.

⑤ Continuous traction method: For cervical spine fractures with slight displacement and no joint locking, the occipital-mandibular Bhutto traction is generally used. That is to say, the occipital jaw Bhutto covers the occipital and mandible, and the head and neck are slightly extended by the pulley, and the traction weight is 2 kg ~ 3 kg, and the traction is continued for 4 ~ 6 weeks.

Extended spinal fractures are rare. If the cervical spine is injured, the cervical spine can be pulled by the neutral occipital jaw Bhutto, and the cervical spine can be slightly flexed if necessary. No spinal cord injury, continuous traction for 4 weeks to 6 weeks, change the neck brace or plaster collar protection. When the lumbar spine is injured, the spine should be prevented from stretching back, and the spine should be placed in a straight or slightly flexed position as needed.

2. Fixation method

After the reduction of spinal fracture and dislocation, it should be properly fixed. Generally, simple thoracolumbar compression fractures must be supine on a hard bed with a soft pillow at the fracture part. Stay in bed for 3 ~ 4 weeks. For unstable thoracolumbar fractures, spine fracture splints or plaster vests and metal brackets should be used for fixation for 4 weeks to 6 months, and surgery can be performed if necessary. After reduction and continuous traction, patients with cervical fracture and dislocation can be fixed with neck brace or plaster collar.

3. Exercises

Thoracolumbar fractures can be restored and treated through exercises, which can not only restore the compressed vertebral body and maintain the stability of the spine, but also increase the muscle strength of the back muscles due to early activities, so as not to cause osteoporosis, and also avoid or reduce the chronic low back pain. If there is no simple compression fracture with complications such as shock after injury, you should start practicing gradually from the second day after reduction, and generally you can get out of bed with splint after 4 weeks. For unstable fractures, you should start practicing after staying in bed for 1-2 weeks, and get out of bed after 6-8 weeks, and you must use thoracolumbar splint to fix it. You should avoid bending forward for 4 months after the injury.

Exercises for flexion-type spinal fractures should be carried out in the following order:

Five-point support method: The patient lies on his back on a hard bed, and supports the whole body with his head, elbows and heels at five points, so that his back can be stretched out as far as possible. This method can be used early after injury.

Three-point support method: still lying on the back, the patient supports the whole body with his head and double heels, and tries his best to hang his back and stretch it out, with his upper limbs flexed and draped over his chest. This method is suitable for the middle and late stage of fracture.

Four-point support method: still lying on your back, hold your upper limbs high above your head, support your palms on the bed, and force your feet and palms at the far end to vacate your body at the same time and stretch out like an arch bridge. This method is suitable for middle and late stage of fracture, especially for young and middle-aged patients.

swallow-dropping method: the patient takes a prone position, with both upper limbs extended backward, and both lower limbs straight and close together. While the upper limbs are extended backward and the head and back are extended backward as far as possible, the lower limbs are extended backward, and the whole body is tilted up, so that only a little bit of the abdomen is landed in an arc like a swallow's water. It is suitable for the middle and late stage of fracture.

4. Drug treatment

Treatment based on syndrome differentiation in three stages of traumatology.