Spinal cord firearm injury

Introduction to spinal cord firearm injuries Spinal cord firearm injury is an open injury of the spinal cord caused by bullets or shrapnel. Due to the damage of important organs in the neck, chest and abdomen, the injury tends to be complicated, and the damage of the spinal cord itself is mostly complete and the prognosis is poor. basic knowledge The proportion of illness: this disease is rare, the incidence rate is about 0.0001% - 0.0002% Susceptible people: no special people Mode of infection: non-infectious Complications: lead poisoning abdominal pain dementia headache

Cause of spinal cord firearm injury

(1) Causes of the disease

Spinal cord injury caused by bullets or shrapnel.

(two) pathogenesis

In the spinal cord firearm injury, the bullet's ability to injure is directly determined by its mass and speed (E = 1/2 MV2), and the effect of speed is more obvious than the quality, the wound is mostly in wartime. High-speed bullets or shrapnel, whose flying speed is greater than 1000m/s, while low-speed bullets are mainly used in low-speed bullets. Low-speed flying objects cause relatively low-intensity spinal cord injuries. Common impacts are direct impact, compression and contusion, and high-speed flying objects are rolling. Advance, the direct damage to the organization is more serious, when it hits the bone, it can become a secondary projectile, especially the strong lateral impact force formed in the injured road can reach 135kg/cm2 The spinal cord injury caused by high-speed bombs, and even the spinal cord injury caused by high-speed bombs, may not directly hit the spine, causing spinal cord contusion without spinal fracture, punching or shrapnel retention. In addition, the special injury mechanism is gunshot The middle arm tears the back and side cables of the spinal cord from the moment of the nerve.

According to the experimental results of gunshot wound animals, the pathological changes of spinal cord firearm injuries are:

Penetration injury

High-energy projectiles cause spinal cord injury when they pass through the vertebral body or spinal canal, and are classified into the following categories:

(1) Transverse: the wound penetrates the spinal canal, breaks the spinal cord, or penetrates the vertebral body, the energy is transmitted to the spinal cord, causing it to break, the defect is 1 ~ 1.5cm, the broken end is not complete, the dura mater is damaged, the broken end 1 In the range of ~2cm, the gray matter center hemorrhage gradually spreads to the surrounding area, and the entire section is necrotic after 42h.

(2) Complete contusion: The missile passes through the wall of the spinal canal or adjacent part, and the shock wave contuses the spinal cord, but its appearance is still intact, the dura mater is more non-destructive, often accompanied by a fracture, and the change is similar to the above cross section, but more To be serious, progress is faster.

(3) Incomplete contusion: The projectile passes through the paravertebral, intervertebral disc, and shock wave acts on the spinal cord. Its appearance is normal. There are multiple hemorrhagic lesions in the gray matter under the microscope. The white matter changes are not obvious, or only a little degeneration.

(4) mild contusion: the ballistic is slightly farther from the spinal canal (such as through the spinous process), the spinal cord is generally unchanged, and the central gray matter is seen under the microscope.

2. Blind tube injury

When the missile speed is slow, it can stay in the spinal canal or the wall of the spinal canal, and the degree of spinal cord injury is one level lower than that of the same site.

Spinal cord firearm injury prevention

The disease is mostly caused by unexpected situations, and there are no effective preventive measures. Pay attention to health, do a good job of safety protection, reduce and avoid accidental injuries, and it can play a preventive role. In case of onset, active treatment should be actively treated to prevent complications.

Spinal cord firearm injury complications Complications lead poisoning abdominal pain dementia headache

The prominent complication of spinal cord firearm injury is infection. The infection can occur in the wound, intraspinal (interdullary or intradural). The prevention and treatment methods focus on thorough debridement, adequate drainage and a large number of antibiotics applied throughout the body. The possibility of lead poisoning, especially when the shrapnel is directly in contact with the cerebrospinal fluid or the formed pseudocyst liquid phase, the lead component contained in the shrapnel may be decomposed and cause chronic lead poisoning, mainly manifested as: abdominal pain, dementia, headache, memory loss , muscle weakness, etc., treatment can use ethylenediaminetetraacetic acid (EDTA), diterpene alcohol (BAL) and other metal chelating agents.

Symptoms of spinal cord firearm injuries Common symptoms Urinary dysfunction and urinary retention sensory dysfunction Swelling swelling Motor dysfunction Head and neck activity restricted

Wound condition

Mostly located in the thoracic segment, followed by the waist, neck segment, and most in the crotch segment, which is related to the length of the segment of each part, the wound is heavily polluted, and there may be cerebrospinal fluid or spinal cord tissue outflow.

2. Characteristics of spinal cord injury

Due to the turbulent zone and contusion effect of the firearm wound in addition to the original invasive tract, the plane of damage to the nervous system function at the time of injury can be several segments higher. With the recovery of this pathological change, the damaged plane may Decline, therefore, should be considered in the early stage of spinal laminectomy after injury, similar to spinal cord injury, complete injury is the majority.

3. Combined injury

The neck can be accompanied by large blood vessels, trachea and esophageal damage, half of the chest and abdomen combined with blood, pneumothorax, abdominal visceral injury or retroperitoneal hematoma, therefore, the incidence of shock is high.

Spinal cord firearm injury check

Lumbar puncture may be found when there is blood or shed spinal cord tissue in the cerebrospinal fluid, which proves that the spinal cord is damaged, at least in the subarachnoid space.

X-ray film

Observe the bullet or shrap in the spinal canal, the position of the paravertebral, and whether there is a fracture. The severity of the spinal cord injury is estimated according to the damaged part of the vertebra.

2. CT scan

When the lesion on the X-ray film is unclear, the CT scan of the axial axis can indicate the location of the fracture. There are no fractures or metal fragments in the spinal canal, and there is no intraspinal hematoma.

3.MRI

MRI can accurately display the damage of the spinal cord and has an irreplaceable advantage. However, whether MRI is used in the spinal cord firearm injury, especially when the shrapnel is located in the intramedullary, it should be carefully analyzed. The strong magnetic field generated by MRI scanning may be Displace the shrapnel located in the marrow, causing more serious damage, and the metal foreign body itself can also cause artifacts in the examination. MRI examination can be most accurately displayed in the injury, especially when there is no metal warhead or shrapnel in the spinal canal. Damaged spinal cord.

Diagnosis and diagnosis of spinal cord firearm injuries

In view of the high incidence of spinal cord firearm injuries or combined injuries, the first emphasis is that the diagnosis of life-threatening combined injuries cannot be missed. If necessary, angiography should be performed to determine whether there is damage to the large blood vessels. The spinal cord firearm injuries are generally based on the entrance and exit of the gunshot wounds. The initial diagnosis can be made in the direction of the injury and the nervous system symptoms of the spinal cord injury. The degree of damage to the nervous system at the time of injury also needs to be recorded and evaluated by Frankel classification or ASIA score. When the injury is allowed, the auxiliary examination is selectively performed. The exact plane and severity of spinal cord damage.

Differential diagnosis

Spinal cord closure injury

After the patient is hit by a bullet or shrapnel, it can roll and fall, causing spinal fracture, dislocation, compression of the spinal cord. X-ray examination can be found that the vertebral body is compressed, and it is wedge-shaped, often accompanied by dislocation. Firearm injuries generally only see the vertebrae. The damage does not affect the stability of the spine.

2. Lumbosacral plexus injury

Firearm injuries with unilateral cones and cauda equina are sometimes difficult to identify, and the latter wear bloody cerebrospinal fluid.

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