CHN THNG CT SNG TY SNG

ThS.BS. Chu Tn S Khoa B mn Ngoi Thn Kinh

M U
CTCS thng li nhiu di chng nng n v mt kinh t - x hi cho BN , gia nh v x hi . M , 10 000 ca CTCS nng/nm , 2-8/ 100000 dn/nm, do TNGT v th thao.

Nguyn nhn
40 - 50%
10 - 25%

10 - 20%

10 - 25%

Phn on
50%

10%

25%

15%

I. C CH CHN THNG
Chn thng trc tip: him Chn thng gin tip : bao gm Gp qu mc (1) Dui nga qu mc (2) Kt hp c hai (1) + (2) : Whiplash injury Nn p theo chiu ng dc Trt xoay theo trc ngang : him

II. GII PHU BNH HC

1. Tn thng xng : Tn thng thn t sng : gy nt, nhiu mnh, gp gc, trt, git l (tear-drop) Gy chn cung Gy khi khp trn , di , eo Gy bn sng , mm gai , mm ngang 2. Tn thng dy chng : trt khp , bong gn lnh tnh 3. Tn thng a m : thot v

II. GII PHU BNH HC

4. Tn thng ty sng , thn kinh : t ty mt phn : hi chng ty trung tm (syringomyelie), hi chng ct trc, ct sau , ct bn (Brown-Sequard) t ty hon ton : mt ton b vn ng , cm gic pha bn di tn thng (3% BN c th hi phc mt phn sau 24 gi )

t ty mt phn

II. GII PHU BNH HC

Shock ty : c hai dng LS khc nhau : - Tt huyt p (shock) sau tn thng ty sng: do nhiu c ch phi hp : tn thng h thng TK thc vt , mu tnh mch do mt trng lc c ca vng lit v mt mu do a chn thng gim th tch tun hon. - Mt tm thi tt c cc phn x bn di tn thng : ko di 2 tun n vi thng

II. GII PHU BNH HC

Dp ty , xut huyt , hoi t , ph n xut hin sau vi pht n vi gi , cht xm trung tm b tn thng lan rng ra cht trng phn ng TB m, thoi ha, nang... 5. Tn thng r TK : t , dp , chn p 6. Tn thng mng ty : rch , mu t NMC , DMC , nang mng nhn 7. Tn thng mch mu nhn ty

Thuyt ba ct ca Denis
ct trc : d/c dc trc , trc thn sng v nhn m, ct gia : d/c dc sau, sau thn sng v nhn m, ct sau : phc hp sau gm d/c lin gai , d/c vng , khi khp v cc mm xng .

III. S MT VNG CT SNG

Tn thng nh : thng gy cc mm gai , mm ngang , khi khp Tn thng nng : gm 4 nhm
Gy nn (Compression fracture): D6 - D8, D12 - L3 Gy tn thng ct trc v khng tn thng TK Gy v (Burst fracture): D10 - L2. Gy tn thng ct trc v ct gia . 50% c tn thng TK (5% lit hon ton) Gy gp qu mc (Seat-bell fracture): gy tn thng ct gia , ct sau v khng tn thng TK Gy trt (Dislocation fracture) : thng gy tn thng c 3 ct v c tn thng TK

III. S MT VNG CT SNG

Gy ct sau v cc tn thng nh khng mt vng . Gy ct trc n c th thng khng mt vng . C 3 loi mt vng : (1) c hc , (2) thn kinh v (3) c hai . Gy ct gia thng b mt vng , tr mt s trng hp gy nh hoc gy CS ngc m xng sn v xng c cn nguyn vn.

IV. CC DNG HNH THI

1. Ct sng c : - Gy C1: Gy Jefferson (gy cung trc, cung sau), gy mt bn , hai bn , kt hp gy C2 . - Gy C2 : thng xy ra la tui 20-30 v 60-70 , gm : - Gy hai chn cung : tn thng c hai eo - Gy mm rng : I (gy nh) , II (gy c) , III (gy nn). Ring II cn xc nh hng gy ra trc hay ra sau , c th to nn khp gi - Gy C2C3 kt hp : thng gy mt vng v km theo cc tn thng khc - Cc tn thng thn CS c thp thng phi hp vi cc tn thng mt khp. - Him gp : trt C0C1 , bong gn , trt xoay C1C2 2. Ct sng lng tht lng : Phn ln cc tn thng ny tp trung vo tng D12 L2 , vi a dng cc c ch tn thng .

V. LM SNG
CTCS / a chn thng RCNAGO c bit ch CTCS / CTSN . Tnh hung tai nn , c ch chn thng V tr au , d cm , yu chi S nn : n ct sng tm im au chi , vng c co tht phn ng

V. LM SNG
Xc nh cc tn thng thn kinh : Vn ng : sc c 0/5 5/5 . Ch khm tng nhm c tng chi , xc nh s yu lit ca chi Cm gic : khm theo tng khoanh da (dermatome) C vng : cu bng quang , co cng dng vt . xc nh v tr tn thng tng ng .

V. LM SNG
Nhng tn thng thn kinh thng gp : yu , lit nhm c , yu lit chi ri lon h hp do lit c honh (C4) d cm , gim cm gic , mt cm gic tn thng r thn kinh hi chng ty trung tm (syringomyelie) hi chng ct sau , ct trc , ct bn (BrownSequard), chp ty , chm ui nga Ri lon thn kinh thc vt : shock ty

VI. CN LM SNG
1. X quang : cc t th thng , nghing , . Vi CS c : h vai kho st C6C7D1 Gy mm rng C2 : t th h ming X quang t th ng (dynamique) : thc hin cn thn vi BS chuyn khoa, ch nh trong nhng trng hp X quang bnh thng nhng c du tn thng thn kinh, kho st s mt vng do tn thng dy chng .

VI. CN LM SNG
2. CT Scanner ct sng : kho st cc tn thng xng , mu t trong ng sng , a m 3. MRI ct sng : kho st tn thng a m, dy chng , mu t , nht l cc tn thng trong nhu m ty sng SCIWORA (Spinal Cord Injury Without Radiographic Abnormality): tn thng ty sng m khng c hnh nh Xquang bt thng .

VII. XTR
1. S cu : ch bt ng ng phng php , chuyn nghip

VII. XTR
2. iu tr triu chng : ch nh trong trng hp khng c tn thng TK v gy vng gim au gin c an thn bt ng : minerve , o np ct sng , vn cng

Phc Corticoide
Tn thng thn kinh, Methylprednisolone (Solumedrol*) liu cao , sm ( < 8 gi u) . Gi th 1 : 30 mg / kg / gi , truyn tnh mch khong 15 n 30 pht . Gi th 2 n gi th 24 (23 ln) : 5,4 mg / kg / gi , tim tnh mch chm. Ch : cc chng ch nh Corticoide , phng xut huyt tiu ha .

iu tr phu thut
Ch nh trong nhng trng hp gy mt vng , hp ng sng , thot v a m . Ko nn ct sng c : t mc Crutchfield, Gardner , halo Phu thut lm rng ng sng : ct bn sng gii p , ly thot v a m Phu thut lm vng ct sng : li trc , li sau , c ghp hoc khng ghp

Ko nn ct sng c

VIII. BIN CHNG

1. Lot chn p : hoi t da do t xoay tr mi 3 gi . 2. Nhim trng : nhim trng tiu , nhim trng h hp do nm lu , t xoay tr xoay tr, v lng, chm sc ng thng tiu , khng sinh 3. Vim tc tnh mch chi : do nm lu , t vn ng xoay tr , xoa bp , mang v b chi , thuc khng ng 4. Co cng chi (spasticite) : vt l tr liu , thuc gin c (Lioresal , Baclofen ) , phu thut Neurotomie , DREZ cn ch vai tr ca vt l tr liu trung tm Phc hi chc nng Ty sng .