Chest radiography

Simple thoracolumbar compression fracture means that the fracture is stable, and there is no spinal attachment fracture and no symptoms of nerve injury. Since 1998, 25 cases of this kind of patients have been treated and cared by pillow and functional exercise, and the function of thoracolumbar spine has basically recovered with satisfactory results. The nursing points are summarized as follows.

Clinical data of 1

Among the 25 patients, male 15 and female 10. Age 18 ~ 65 years old. Among them, fall 14 cases, traffic accidents in 5 cases and accidents caused by daily activities in 6 cases. Spinal injury: T 1 1 ~ L 222 cases, accounting for 88%, and other spinal injuries in 3 cases, accounting for 12%. All patients were treated with pillow and functional exercise, and the effective rate was 100%. The function recovered quickly without complications, and the average hospitalization was 50 days.

2 nursing

2. 1 psychological care is the early stage of psychological care and physical rehabilitation care. Because the patient's psychological disorder is caused by physical trauma, physical rehabilitation is conducive to psychological rehabilitation. Nurses should fully understand the patient's injury in time, strengthen communication with patients, and conduct targeted psychological counseling. Explain clearly the process of fracture healing and the purpose of functional exercise to patients in plain language, so as to eliminate tension, enhance rehabilitation confidence, mobilize patients' subjective initiative and strive for close cooperation.

2.2 Pain is a common sign of fracture, which not only causes physical pain to patients, but also increases negative emotions, affecting sleep and rest, which is not conducive to rehabilitation. Nurses can use psychological support therapy to relieve pain, one is to distract attention and reduce pain perception; The second is to carry out pain knowledge education in advance to change the pain response. Maintaining a good attitude is conducive to increasing the tolerance for pain.

2.3 Patients with lying position and suboccipital injury should lie on the hard bed after hospitalization, and take off the pillow to keep the spine straight and prevent deformity or further injury [1]. At the same time, according to the degree of fracture compression, placing appropriate soft pillows under the injured vertebral body can first decrease and then gradually increase. This method makes use of the principle of trunk gravity and lever to make the spine stretch backward stably and gradually recover, so that the compressed vertebral body can be expanded and the fracture deformity can be corrected [2]. Patients must adhere to the pillow, the course of treatment is not less than 6 weeks.

2.4 Reduce abdominal distension and keep defecation unobstructed. After fracture, retroperitoneal hematoma often stimulates visceral nerves, causing reflex intestinal paralysis, leading to abdominal distension or feces staying in the intestine for too long and causing pain. Therefore, patients should eat more high-fiber and digestible foods, avoid spicy and irritating foods, and drink more water. Give circular massage, anal exhaust or clean enema when abdominal distension occurs. For patients with dysuria caused by abdominal distension, local hot compress, listening to the sound of running water, acupuncture or catheterization can be used.

2.5 Do skin care to prevent complications. After fracture, patients need to lie on the hard bed for a long time and can't take care of themselves. Nurses should regularly help and guide patients to turn over on the axis, that is, shoulder and hip turn over at the same time to avoid limb twisting and spinal torsion. When turning over, the patient is required to straighten his back and tighten his back muscles to form a natural internal fixation splint, generally every 2 ~ 3 hours 1 time. Keep the skin clean, take good care of the skin, regularly massage the back and local compression parts, promote blood circulation and prevent bedsores.

2.6 Functional exercise

2.6. 1 Meaning After fracture, through functional exercise, the tension of the anterior longitudinal ligament of the spine and the annulus fibrosus of the intervertebral disc and the muscle splint function of the back muscles can be exerted to avoid soft tissue adhesion and tissue fibrosis. Insisting on exercise can obviously reduce the sequelae of chronic low back pain and other fractures, and at the same time, it can also promote systemic blood circulation and prevent osteoporosis and muscle atrophy [3]. So after the pain is relieved, you should exercise your back muscles as soon as possible.

2.6.2 The principle is to start as early as possible, from easy to difficult, from small to large, from less to more, from short to long, step by step and persevere. Give priority to patients' active activities and avoid rude passive activities.

2.6.3 Method (1) Decreasing period: pillow 1 ~ 2 weeks, encourage patients to practice active abdominal lifting, 1 day, 3 times, 5 ~ 10 min each time. (2) Five-point support method: supine, with the head, elbow and heel supporting the whole body at five points, making the back stretch in the air, about 1 week after the injury. (3) Three-point support method: supine, arms on the chest, head and feet support, arch waist, hips and back out of bed, which is beneficial to the exercise of back muscles. Do this exercise 2 ~ 3 weeks after injury. (4) Four-point support method: Lie on your back, support your hands and feet on the bed at 4 o'clock, and fly in an arch bridge shape, 3-4 weeks after injury. (5) Swallowing water method: Lie on your stomach, stretch your neck slightly backward, then lift your chest off the bed surface, extend your upper limbs to your back, straighten your knees, and lift your legs with your abdomen as the support point, which looks like swallowing water. Practice after 5 ~ 6 weeks.

3 discharge guidance

Instruct patients to continue functional exercise after discharge, but avoid fatigue and trauma; Strengthen nutrition and physical fitness, and explain in detail the importance of time spent in the wild. After 6 ~ 7 weeks of treatment, patients should stand and step according to their recovery, and the time should not be too long. After 3 months, I began to practice bending forward, insisted on lying on the hard bed, continued to put pillows, and came to the hospital for regular review.

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(1) Etiology, pathology and clinical features: Lumbar compression fracture, called "broken lumbar bone" in ancient times, refers to a kind of spinal fracture characterized by "flattening" of the longitudinal height of vertebral body, and is also the most common type of spinal fracture. Clinically, 1 1, 12 thoracic vertebrae and 1 2 lumbar vertebrae are the most common, and the incidence of osteoporosis in the elderly is high. Common reasons are as follows:

① Indirect violence: the most common. It is more common to fall from a height. After the hips or feet touch the ground, the force is transmitted to the waist. Or heavy objects fall from a height and hit the head, shoulders and back, and the force is transmitted downward to the waist, resulting in fractures; Some elderly people have severe osteoporosis, and some minor injuries, such as car bumps and sitting on the ground, can also cause spinal fractures.

② Muscle tension: When the lumbosacral muscles suddenly contract strongly, considerable tensile stress can be generated, which usually leads to fracture of vertebral appendages, such as transverse process and spinous process. Severe muscle contraction caused by tetanus or other nervous system diseases can lead to thoracolumbar compression fractures.

③ Direct violence: rare in peacetime. It can be seen in traffic accidents, firearm injuries or direct blows to the waist. This kind of injury often causes spinal cord injury and has serious consequences such as paralysis in different degrees.

(2) Diagnostic basis: Most of them have a clear history of trauma; Local swelling and pain in chest and waist, with kyphosis in appearance, local tenderness and percussion pain, and unfavorable waist movement; Patients with bone marrow injury may have different degrees of dysfunction; X-ray film can make clear the type and degree of fracture; CT and MRI can determine the degree of spinal cord compression.

There are many clinical classification standards for spinal fractures, and there are different classification methods according to different standards.

① Stable fracture: any simple vertebral compression fracture (the compression in front of the vertebral body does not exceed 1/2 of the thickness of the vertebral body, and there is no accessory fracture or ligament tear); Or simply attached (transverse process, spinous process or unilateral lamina, pedicle) fracture is a stable fracture. This kind of fracture has little effect on the stability of the spine, generally without ligament injury and obvious displacement tendency. The treatment is simple, more conservative and the prognosis is better.

② Unstable fracture: Any vertebral body compression exceeding the vertebral body thickness 1/2, comminuted, or fracture accompanied by dislocation, adnexal fracture or ligament tear is an unstable fracture. This kind of fracture is mostly caused by strong violence, the stability of the spine is destroyed, and it is often complicated with ligament tear and spinal cord or spinal nerve root injury. The treatment is difficult, most of them need surgery and the prognosis is poor.

(3) Treatment based on syndrome differentiation: firstly, it is clear whether the fracture is stable, whether there is spinal cord, cauda equina and spinal nerve root injury, and the degree of injury, and then the treatment plan is formulated. Basically, according to the principle of fracture management, it is reduction, fixation, exercise and drug treatment.

① stable fracture: generally, you need to lie on a hard bed for 6-8 weeks. Patients with compression fracture can be treated with pillow therapy, and the suitable height of pillow is about 8 ~ 10 cm. This kind of fracture combined with training therapy has a better effect, because correct and appropriate training can not only restore the compressed vertebral body and maintain the stability of the spine, but also increase the strength of the back muscles because of early activities, so as not to produce or aggravate osteoporosis, and also to avoid or alleviate chronic low back pain. Specific practices:

Five-point support method: the patient lies on his back on the wooden bed, supports the whole body with his head, elbows and heels at five points, and stretches his back as much as possible. This method can be used in the early stage.

Three-point support method: it is developed on the basis of five-point support method. The patient puts his arms on his chest and supports them with his head and feet to make his whole body fly and stretch backwards. This method can be used in the middle and late stages.

Swallowing water method: also known as "one-point method", the patient is prone, the upper limbs are extended backward, and a pillow is placed at the calf and ankle to make the head and shoulders lean back as far as possible. At the same time, their lower limbs are as straight as possible, and their whole bodies are tilted upward, leaving only their abdomen in an arc, commonly known as "double-headed tilt". This method requires higher requirements, and the first two methods are often used after a period of exercise.

② Unstable fracture: If there are no symptoms of spinal nerve injury in clinic, conservative treatment can also be considered, but the exercise time should be slightly delayed and the bed rest time should be slightly longer. Surgical treatment should be considered for those with signs of spinal cord nerve injury.

③ Complete spinal cord injury: early operation (preferably within 8 hours), open reduction, complete decompression and internal fixation; And it is best to start taking enough glucocorticoid (methylprednisolone) within 1 hour after injury and keep it for 1 ~ 3 days to minimize spinal cord injury.

④ Incomplete spinal cord injury: In addition to medication and immobilization, clinical symptoms and signs should be closely observed. If there is aggravation or no obvious improvement, or if there is a large bone mass protruding into the spinal canal after CT and MRI examination, spinal cord and nerve root surgery should be performed as soon as possible; If you get better gradually, you can continue conservative treatment. Patients with spinal nerve root injury can refer to the treatment of incomplete spinal cord injury. TCM treatment can be divided into early, middle and late stages:

Early stage: local swelling, severe pain, loss of appetite, constipation, thin white fur and tight pulse. Syndrome belongs to qi stagnation and blood stasis. Treatment should promote qi and blood circulation, remove blood stasis and relieve pain. Prescriptions include Fuyuan Huoxue Decoction and Gexia Zhuyu Decoction. Xiao Zhong ointment or Xiaoyu ointment can be used externally. If abdominal distension, pain and dysuria occur at the same time, it is blood stasis and bladder gasification disorder. It is advisable to promote blood circulation and remove blood stasis, and promote qi and water. Optional Gexia Zhuyu decoction combined with Wuling powder; If the local pain persists, abdominal pain, constipation, thick yellow fur and strong pulse will occur. It is blood stasis and qi stagnation, and the internal organs are blocked. Taohe Chengqi Decoction and Dachengqi Decoction should be used to treat the disease.

Mid-stage: Although the swelling and pain disappear and the degree is reduced, the activity is still limited, with dark red tongue, thin white fur and slow pulse. The syndrome is blood stasis, and the bones and muscles are not healed. Treatment should promote blood circulation, harmonize camp and health, set bones and continue tendons. You can use Fuyuan Ventilation Powder or Xugu Huoxue Decoction.

Late stage: backache, leg weakness and limb weakness can be seen. Local dull pain after exercise, white fur and pale tongue, weak and thin pulse. The syndrome is deficiency of liver and kidney and deficiency of both qi and blood. Treatment should benefit liver and kidney and regulate qi and blood. Fang used Dihuang Yinzi.

It is very important to give first aid to such patients, especially when transporting them. The method of lying down should be adopted, with everyone's head, back, waist, hips and legs supported together, or the injured person should be moved to a wooden stretcher or a thick padded hard bed by rolling. When making diagnosis, local CT or MRI examination should be done as much as possible to understand the situation and degree of injury and help decide the treatment plan. During the treatment, before fully understanding the condition, you must not blindly perform bonesetting reduction to avoid aggravating the injury; In addition, for paraplegic patients, nursing should pay special attention to prevent bedsore, urinary tract infection, lung infection and constipation, and it is also important to carry out necessary functional exercise at an early stage.