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RAHIS
S.U.U.M.C. “”Carol Davila” Bucuresti
Clinica de Ortopedie – Traumatologie
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3 curburi
• Lordoa cervicala
• Ci!oa dorsala
• Lordoa lom"ara
Anatomie
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Achizitia curburilor
Cele # cur"uri sunt consecinta statusului "iped
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Cervicala
Toracala
Lombara
morfologie vertebrala
• Talie di!erita
• $orme di!erite• %nclintia !atetelor
25°
9°
!°
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Coloana de copil Coloana de adult
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Canalul me"ular normal
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Canal me"ular normal
Cor# vertebral
Canal $#inal cu ma"uva
A#ofiza tran$ver$a
A#ofize articulare
A#ofize $#inoa$e
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%i$c normal
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%i$c normal
& ' a#a 3 ' #roteoglicani
Annulu$
fibro$u$
(ucleu$
#ul#o$u$
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S#atiul "i$cal
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S#atiul mobil al lui )unghan$
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*i$cari "e fle+ie,e+ten$ie
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*i$cari "e fle+ie,e+ten$ie
& Bascula dupa un centru de rotatie situat posterior de disc& Diminuarea !oramenului in e'tensie
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*obilitatea rahi$ului cervical
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H-R(IA %ISCALA
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Hernia "i$cala
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Herniile "i$cale
(ucleul #oate bomba in
ligamentul intact .
hernie $au #rotruzie "i$cala
-+teriorizare #rin ligament .
Com#re$ia uneia $au mai multor
ra"acini nervoa$e
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Semne clinice
• Lom"algie
• Contractura
• Sciatalgie
Contractura algica paraverte"rala
(titudine scoliotica
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Semnul LAS-/0-
Compresia unei radacini
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$oraminala Laterala Mediana
Localizarea herniei $i $ituatiile clinice
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1 hernie laterala #oate
com#rima $au 2ra"acini a"iacente
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Compresia L)
Durere si sensi"ilitate Motricitate *e!le'e
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Cruralgie
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Com#re$ie L5
Dureri si sensi"ilitate
Motricitate
*e!le'e
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Com#re$ie S
Durere si sensi"ilitate Motricitate *e!le'e
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*ielografie o#aca
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CT&ul poate localia +erniile
!oraminale
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R*(
+ernie
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R*(
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%i$cografie
,ucleograma patologica
normal
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Tratamentul herniilor "e "i$c
• Tratament medical
– *epaos & antalgic – (%,S
– Decontracturante
– Masa-
– *eeducare musculara
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Chimionucleoliza
• %n-ectie de enime c+imiopapaina/
• Discogra!i epreala"ila
• 0ernie su"ligamentara unica
• *eactie ana!ilactica 11
• Contra&indicatie 2 alergie
• ,u poate !i utiliata decat o singura data
• *eultate "une 345/
• Lom"algies reiduala
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Tratament chirurgical
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Sindrom de coada de cal ,ucleu e'tirpat
%i$cectomie chirurgicala
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disc normal disc degenerat
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%ISCARTR1A
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Degenerescenta cu protruie 6rotruie dicreta
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Con$ecintele #en$arii "i$cale
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Canal lombar ingu$tat artrozic
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S#on"ilo"i$cita "egenerativa
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Stenoza canalara
Diametru sagital !i' Diametru sagital mo"il
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4rofil clinic
• Lom"algii 1 poliradiculopatii 1 claudicatie 2 78 5
• Lom"algii 1 monoradiculalgie 1 claudicatie 2 93 5
• Lom"algii 1 poliradiculalgie 2 94 5
• Lom"algii 1 monoradiculalgies 2 7: 5
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Tratamentul canalului lombar ingu$tat
(ugmentare c+irurgicala 2 laminectomie
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(rtrodea cu interpoitie de ca-a si osteosinteaposterioara
Tratamentul canalului lombar in$tabl
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Artroza cervicala
,evralgie cervico "ra+iala prin compresie radiculara
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Artroza cervicala
(rtroa poate implica artera verte"rala
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Artroza rahi$ cervical
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Canal normal Canal ingust
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Artro"eza cervicala
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RACT0RIL- T1RACAL- SI
L1*6AR-
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racturile rahi$ului
$recventa 2 8) la 944.444 locuitori
*a+is lom"ar 2 )8 5cu tul"urari neuro 2 3 5
mortalitate ) 5/
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Localizarea fracturilor rahi$ului
• C,C2 . 7 '
• C3 , C& . 3 '
• % , % . & '
• % , L2 . 55 '
• L3 , L5 . & '
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Circumstante
Cadere de la inaltime
(ccidnte rutiere
(ccident de munca
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• Cel mai a"e$ea fracturi ta$are 8$tabile
• In$tabilitate In caz "e .
– *uptura de ligamente posterioare – $ractura apo!ielor spinoase – $ractura unei !atete – $ractura unui pedicul
– $ractura cominutiva de corp
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6rognosticul depinde de complicatiileneurologice si de insta"ilitate
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Leiune prin compresie
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Leiune prin distractie posterioara
Analiza ra"iologica
S#on"iloli$tezi$ #ur
traumatic
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Lu'atie posterioara
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Tratamentul fracturilor lombare cu ta$are "e #e$te 2°
Re"ucere #rin hi#erlor"oza
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Metoda B;0L
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Metoda B;0L
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Confectionarea unui cor$et
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Tulburari neurologice
racturi cominutive
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racturi cominutive
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Sco# .
-liberarea canalului lombar in caz "e com#re$ie
neurologica
Re"ucerea "eformarii
Stabilizarea leziunilor
Tratament chirurgical
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Ti:e Harrington
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6laca si suru"uri
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$i'are transpediculara
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RACT0RIL- %- 6AI(
A(AT1*I-
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A(AT1*I-
A(AT1*I-
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A(AT1*I-
A(AT1*I-
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A(AT1*I-
A(AT1*I-
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A(AT1*I-
A(AT1*I-
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A(AT1*I-
A(AT1*I-
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A(AT1*I-
6I1*-CA(ICA
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6I1*-CA(ICA
;ASC0LARIATI-
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;ASC0LARIATI-
I(-R;ATI-
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I(-R;ATI-
C S 1 C
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*-CA(IS* %- 4R1%0C-R-
&
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-(-R/I- )1ASA
& *am iliopu"ian sau?si isc+iopu"ian.
& (vulsia de2 spina iliaca anterosuperioara spina iliaca anteroin!erioara
tu"eroitate isc+iatica.& %olata transversala/ de sacru.
& (ripa iliaca
-(-R/I- I(ALTA
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-(-R/I- I(ALTA
& (utove+icule& impact anteroposterior & impact lateral
& ta"lou de "ord
& Motocicleta & impact in seut
& impact in genunc+i
& 6ieton & impactul cu ve+iculul& & !rontal
& lateral
-(-R/I- I(ALTA
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& Cadere de la inaltime& – in “picioare” & pe “o parte”
& Mecanisme penetrante& arme de !oc
& arme al"e
& @dro"ire
CLASIICAR-
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CLASIICAR-
I$toric & Clasi!icare anatomica
in !unctie de sediul leiunii
&Clasi!icare anatomopatologicain !unctie de numarul de intreruperi
ale inelului pelvin.
& %n !unctie de mecanismul de producere2 compresiune anteroposterioara
compresiune laterala !or!ecare verticala a'iala/
Cla$ificarea TIL-
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Cla$ificarea TIL-
TA6< (
• Sta"le• (9$ractures o! t+e pelvis not involving t+e ring• (7Sta"le minimall displaced !ractures o! t+e ring• TA6< B
• *otationall unsta"le verticall sta"le• B9Open "ooE• B7Lateral compression2 ipsilateral• B#Lateral compression2 contralateral "ucEet&+andle/• TA6< C
• *otationall and verticall unsta"le• C9*otationall and verticall unsta"le• C7Bilateral• C#(ssociated Fit+ an aceta"ular !racture•
•
I(STA6ILITAT- R1TATI1(ALA
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I(STA6ILITAT- R1TATI1(ALA
I(STA6ILITAT- ;-RTICALA
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Cla$ificarea
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• LC Transverse !racture o! pu"ic rami ipsilateral or contralateral to posterior in-ur• %Sacral compression on side o! impact
• %%Crescent iliac Fing/ !racture on side o! impact
• %%%LC&% or LC&%% in-ur on side o! impactG contralateral open&"ooE (6C/ in-ur
•
• (6C Smp+seal diastasis or longitudinal rami !ractures• %Slig+t Fidening o! pu"ic smp+sis or anterior S% -ointG stretc+ed "ut intact
anterior S% sacrotu"erous and sacrospinous ligamentsG intact posterior S% ligaments
• %%Hidened anterior S% -ointG disrupted anterior S% sacrotu"erous andsacrospinous ligamentsG intact posterior S% ligaments
• %%%Complete S% -oint disruption Fit+ lateral displacementG disrupted anterior S%sacrotu"erous and sacrospinous ligamentsG disrupted posterior S% ligaments
Cla$ificarea
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Cla$ificarea
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-=A*-(0L CLI(IC
& 6alparea crestelor iliace
& S%(S – Manevra de apropiere sau
departare – (T
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-=A*-(0L RA%I1L1/IC
-=A*-(0L RA%I1L1/IC
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-=A*-(0L RA%I1L1/IC
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-=A*-(0L RA%I1L1/IC
%IA/(1STIC
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TOMO=*($%( COM6UT
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Hemoragia
& Cea mai reduta"ila complicatie& Sursa2 !ocarul de !ractura
& leiuni arteriale sau?si venoase
& locale
& leiunmi de vase mari
& Tratament2 laparatomie cu +emostaa
& arteriogra!ie1 em"oliare
& !i'are e'terna
L-I0(I AS1CIAT-
A t l i
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A#aratul urinar
I
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0 S1C
=
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& *are
& Desc+ise in2 perineu rect vagin
& veica urinara
& e'terior aripa iliaca/.
& T*(T(M
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• LC Transverse !racture o! pu"ic rami ipsilateral or contralateral to posterior in-ur
• %Sacral compression on side o! impact• %%Crescent iliac Fing/ !racture on side o! impact
• %%%LC&% or LC&%% in-ur on side o! impactG contralateral open&"ooE (6C/ in-ur
• (6C Smp+seal diastasis or longitudinal rami !ractures
• %Slig+t Fidening o! pu"ic smp+sis or anterior S% -ointG stretc+ed "ut intactanterior S% sacrotu"erous and sacrospinous ligamentsG intact posterior S% ligaments
• %%Hidened anterior S% -ointG disrupted anterior S% sacrotu"erous andsacrospinous ligamentsG intact posterior S% ligaments
• %%%Complete S% -oint disruption Fit+ lateral displacementG disrupted anterior S%
sacrotu"erous and sacrospinous ligamentsG disrupted posterior S% ligaments•
Cla$ificarea
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• IS Smp+seal diastasis or vertical displacement anteriorl and posteriorl
usuall t+roug+ t+e S% -oint occasionall t+roug+ t+e iliac Fing or sacrum
• CM Com"ination o! ot+er in-ur patterns LC?IS "eing t+e most common
TRATA*-(T
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LC& % (6& % cu minima deplasare/
& tratament simptomatic
& mers !ara incarcare
(6& %% LC& % cu deplasare/ & reducere1 sta"iliare anterioara
LC& %% LC& %%% (6& %%% IS
& reducere1 sta"iliare anterioara si posterioara
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TRATA*-(T
CHIR0R/ICAL
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CHIR0R/ICAL
$%K(TO*UL
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=(,@
I=AT1R0L -=T-R(
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SLATIS
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I=AR- I(T-R(A
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$i'are
sacroiliaca
percutana
I=AR- I(T-R(A
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$i'are
sacroiliaca
percutana
I=AR- I(T-R(A
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Osteosintea sacroiliaca anterioara
I=AR- I(T-R(A
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Osteosintea sacroiliaca anterioara
I=AR- I(T-R(A
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Osteosintea sim!ia pu"iana
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I=AR- I(T-R(A
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$i'are
transiliaca pentru
!racturi de sacru
I=AR- I(T-R(A
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$i'are
transiliaca pentru
!racturi de sacru
C1*4LICATII
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%,$
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