14. Rahis bazin.ppt

8/17/2019 14. Rahis bazin.ppt

1/132

RAHIS

S.U.U.M.C. “”Carol Davila” Bucuresti

Clinica de Ortopedie – Traumatologie


2/132


3/132


4/132

3 curburi

• Lordoa cervicala

• Ci!oa dorsala

• Lordoa lom"ara

Anatomie


5/132

Achizitia curburilor

Cele # cur"uri sunt consecinta statusului "iped


6/132

Cervicala

Toracala

Lombara

morfologie vertebrala

• Talie di!erita

• $orme di!erite• %nclintia !atetelor

25°

9°

!°


7/132

Coloana de copil Coloana de adult


8/132

Canalul me"ular normal


9/132

Canal me"ular normal

Cor# vertebral

Canal $#inal cu ma"uva

A#ofiza tran$ver$a

A#ofize articulare

A#ofize $#inoa$e


10/132

%i$c normal


11/132

%i$c normal

& ' a#a 3 ' #roteoglicani

Annulu$

fibro$u$

(ucleu$

#ul#o$u$


12/132

S#atiul "i$cal


13/132

S#atiul mobil al lui )unghan$


14/132

*i$cari "e fle+ie,e+ten$ie


15/132

*i$cari "e fle+ie,e+ten$ie

& Bascula dupa un centru de rotatie situat posterior de disc& Diminuarea !oramenului in e'tensie


16/132


17/132

*obilitatea rahi$ului cervical


18/132

H-R(IA %ISCALA


19/132

Hernia "i$cala


20/132

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


21/132


22/132

Semne clinice

• Lom"algie

• Contractura

• Sciatalgie

Contractura algica paraverte"rala

(titudine scoliotica


23/132

Semnul LAS-/0-

Compresia unei radacini


24/132

$oraminala Laterala Mediana

Localizarea herniei $i $ituatiile clinice


25/132

1 hernie laterala #oate

com#rima $au 2ra"acini a"iacente


26/132

Compresia L)

Durere si sensi"ilitate Motricitate *e!le'e


27/132

Cruralgie


28/132

Com#re$ie L5

Dureri si sensi"ilitate

Motricitate

*e!le'e


29/132

Com#re$ie S

Durere si sensi"ilitate Motricitate *e!le'e


30/132

*ielografie o#aca


31/132

CT&ul poate localia +erniile

!oraminale


32/132

R*(

+ernie


33/132

R*(


34/132


35/132

%i$cografie

,ucleograma patologica

normal


36/132


37/132

Tratamentul herniilor "e "i$c

• Tratament medical

– *epaos & antalgic – (%,S

– Decontracturante

– Masa-

– *eeducare musculara


38/132

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


39/132

Tratament chirurgical


40/132

Sindrom de coada de cal ,ucleu e'tirpat

%i$cectomie chirurgicala


41/132

disc normal disc degenerat


42/132

%ISCARTR1A


43/132

Degenerescenta cu protruie 6rotruie dicreta


44/132

Con$ecintele #en$arii "i$cale


45/132

Canal lombar ingu$tat artrozic


46/132

S#on"ilo"i$cita "egenerativa


47/132

Stenoza canalara

Diametru sagital !i' Diametru sagital mo"il


48/132

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


49/132

Tratamentul canalului lombar ingu$tat

(ugmentare c+irurgicala 2 laminectomie


50/132

(rtrodea cu interpoitie de ca-a si osteosinteaposterioara

Tratamentul canalului lombar in$tabl


51/132

Artroza cervicala

,evralgie cervico "ra+iala prin compresie radiculara


52/132

Artroza cervicala

(rtroa poate implica artera verte"rala


53/132

Artroza rahi$ cervical


54/132

Canal normal Canal ingust


55/132

Artro"eza cervicala


56/132

RACT0RIL- T1RACAL- SI

L1*6AR-


57/132

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/


58/132

Localizarea fracturilor rahi$ului

• C,C2 . 7 '

• C3 , C& . 3 '

• % , % . & '

• % , L2 . 55 '

• L3 , L5 . & '


59/132

Circumstante

Cadere de la inaltime

(ccidnte rutiere

(ccident de munca


60/132

• 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


61/132

6rognosticul depinde de complicatiileneurologice si de insta"ilitate


62/132

Leiune prin compresie


63/132

Leiune prin distractie posterioara

Analiza ra"iologica

S#on"iloli$tezi$ #ur

traumatic


64/132

Lu'atie posterioara


65/132

Tratamentul fracturilor lombare cu ta$are "e #e$te 2°

Re"ucere #rin hi#erlor"oza


66/132

Metoda B;0L


67/132

Metoda B;0L


68/132

Confectionarea unui cor$et


69/132


70/132

Tulburari neurologice

racturi cominutive


71/132

racturi cominutive


72/132

Sco# .

-liberarea canalului lombar in caz "e com#re$ie

neurologica

Re"ucerea "eformarii

Stabilizarea leziunilor

Tratament chirurgical


73/132

Ti:e Harrington


74/132

6laca si suru"uri


75/132


76/132


77/132


78/132

$i'are transpediculara


79/132

RACT0RIL- %- 6AI(

A(AT1*I-


80/132

A(AT1*I-

A(AT1*I-


81/132

A(AT1*I-

A(AT1*I-


82/132

A(AT1*I-

A(AT1*I-


83/132

A(AT1*I-

A(AT1*I-


84/132

A(AT1*I-

A(AT1*I-


85/132

A(AT1*I-

6I1*-CA(ICA


86/132

6I1*-CA(ICA

;ASC0LARIATI-


87/132

;ASC0LARIATI-

I(-R;ATI-


88/132

I(-R;ATI-

C S 1 C


89/132

*-CA(IS* %- 4R1%0C-R-

&


90/132

-(-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


91/132

-(-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


92/132

& Cadere de la inaltime& – in “picioare” & pe “o parte”

& Mecanisme penetrante& arme de !oc

& arme al"e

& @dro"ire

CLASIICAR-


93/132

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-


94/132

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


95/132

I(STA6ILITAT- R1TATI1(ALA

I(STA6ILITAT- ;-RTICALA


96/132

Cla$ificarea


97/132

• 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


98/132

Cla$ificarea


99/132


100/132


101/132


102/132


103/132


104/132


105/132


106/132


107/132

-=A*-(0L CLI(IC

& 6alparea crestelor iliace

& S%(S – Manevra de apropiere sau

departare – (T


108/132

-=A*-(0L RA%I1L1/IC

-=A*-(0L RA%I1L1/IC


109/132

-=A*-(0L RA%I1L1/IC


110/132

-=A*-(0L RA%I1L1/IC

%IA/(1STIC


111/132

TOMO=*($%( COM6UT


112/132

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


113/132

A#aratul urinar

I


114/132

0 S1C

=


115/132

& *are

& Desc+ise in2 perineu rect vagin

& veica urinara

& e'terior aripa iliaca/.

& T*(T(M


116/132

• 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


117/132

• 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


118/132

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


119/132

TRATA*-(T

CHIR0R/ICAL


120/132

CHIR0R/ICAL

$%K(TO*UL


121/132

=(,@

I=AT1R0L -=T-R(


122/132

SLATIS


123/132

I=AR- I(T-R(A


124/132

$i'are

sacroiliaca

percutana

I=AR- I(T-R(A


125/132

$i'are

sacroiliaca

percutana

I=AR- I(T-R(A


126/132

Osteosintea sacroiliaca anterioara

I=AR- I(T-R(A


127/132

Osteosintea sacroiliaca anterioara

I=AR- I(T-R(A


128/132

Osteosintea sim!ia pu"iana


129/132

I=AR- I(T-R(A


130/132

$i'are

transiliaca pentru

!racturi de sacru

I=AR- I(T-R(A


131/132

$i'are

transiliaca pentru

!racturi de sacru

C1*4LICATII


132/132

%,$

Documents

14. Rahis bazin.ppt