Spinal cord injury: refers to the spinal cord injury caused by external direct or indirect factors, and various motor, sensory and sphincter dysfunctions, abnormal muscle tone and pathological reflexes and other corresponding changes appear in the corresponding segments of the damage. The degree and clinical manifestations of spinal cord injury depend on the location and nature of the primary injury. In Chinese medicine, it belongs to the category of “lumbago”, “impotence” and “retention of urine” caused by trauma and blood stasis. Spinal cord injury can be divided into primary spinal cord injury and secondary spinal cord injury. The former refers to injuries caused by external forces acting directly or indirectly on the spinal cord. The latter refers to further damage to the spinal cord caused by spinal cord edema, hemorrhage of small blood vessels in the spinal canal to form hematoma, compression fracture, and compression of the spinal cord by broken intervertebral disc tissues and other forms of spinal cord compression. Clinical symptoms: Experimental studies have proved that primary spinal cord injury is often localized and incomplete, and after the injury there is a large amount of catecholamine neurotransmitters such as norepinephrine, dopamine, etc. released and accumulated locally, which results in spasm of local microvessels of the spinal cord, ischemia, increased vascular permeability, and rupture of small veins, resulting in secondary hemorrhagic necrosis. This self-destructive phenomenon of large hemorrhagic necrosis in the central part of the spinal cord after spinal cord injury is referred to as hemorrhagic necrosis, which is an important pathological process secondary to spinal cord injury. Spinal cord injury is a serious complication of spinal fracture, in which the displacement of the vertebral body or the protrusion of broken bone fragments into the vertebral canal produces varying degrees of damage to the spinal cord or cauda equina. Thoracolumbar injury causes sensory and motor disorders in the lower limbs, which is called paraplegia, and after cervical spinal cord injury, both upper limbs also have neurological dysfunction, which is called quadriplegia, or “quadriplegia” for short. 1.Spinal cord injury During the spinal cord shock period, there is spastic paralysis below the injury level, loss of movement, reflexes and sphincter function, loss of sensation and inability to control urination and defecation, which gradually evolves into spastic paralysis in 2-4 weeks, manifested by increased muscle tone, hyperreflexia, and pathologic vertebral fasciculations, thoracic spinal cord injury manifests as paraplegia, while the cervical spinal cord injury manifests quadriplegia, and quadriplegia after cervical spinal cord injury, or quadriplegia. The quadriplegia of cervical spinal cord injury is spastic paralysis, and the quadriplegia of lower cervical spinal cord injury is spastic paralysis of the upper limbs due to the destruction of spinal cervical bulging parts and nerve roots, and the lower limbs are still spastic paralysis. Hemilateral spinal cord injury syndrome: also known as Brown-Sequard sign. Complete upper motor neuron paralysis and loss of deep sensation in the limb on the same side below the plane of injury, manifested by spastic paralysis on that side, deep reflex hyperreflexia and pathological reflexes; and loss of nociception and temperature sensation in the limb on the opposite side, or sensory hypersensitivity at the level of slightly higher segments of the injury. Anterior spinal cord injury syndrome: the cervical spinal cord is severely compressed anteriorly, sometimes causing occlusion of the anterior central artery of the spinal cord. The clinical manifestations are tetraplegia immediately below the level of the injury, loss of superficial sensations such as hyperalgesia and hypercapnia, and the presence of deeper sensations such as positional sensation and vibration sensation. It is sometimes accompanied by sphincter dysfunction. Posterior spinal cord injury syndrome: clinical manifestations are mainly sensory deficits and nerve root irritation symptoms. Central spinal cord injury syndrome: Most of the cases occur in cervical hyperextension injury. The cervical spinal canal undergoes rapid volume changes due to hyperextension of the cervical spine, and the spinal cord is squeezed anteriorly and posteriorly by the ligamentum flavum, intervertebral discs, or bony spurs, causing damage to the conduction bundles around the central canal of the spinal cord, which manifests itself as quadriplegia below the plane of injury, with the upper limbs heavier than the lower limbs, and the innervation area of the upper limbs for the 2-3 segments manifesting as damage to the lower motor neurons, and the lower limbs as damage to the upper motor neurons. Hand dysfunction is more obvious, and in severe cases, there is intrinsic muscle atrophy, which is difficult to recover. 2, spinal cord cone injury normal human spinal cord terminates at the lower edge of the 1st lumbar vertebra, so the 1st lumbar vertebra fracture can occur spinal cord cone injury, manifested as perineal skin saddle-like sensory loss, sphincter function loss caused by urinary and fecal inability to control and sexual dysfunction, the sensation of the two lower limbs and movement is still retained normal. 3.Cauda equina injury Cauda equina starts from the sacral spinal cord of the 2nd lumbar vertebrae, and generally ends at the lower edge of the 1st sacral vertebrae, cauda equina injury is rarely complete. The performance of the injury is below the injury plane of retarding paralysis, with sensory and motor dysfunction and loss of sphincter function, reduced muscle tone, tendon reflexes disappear, no pathological vertebral fasciculation signs. Complications: 1, respiratory failure and respiratory infection This is a serious complication of cervical spinal cord injury, the human body has two groups of muscles, thoracic respiration and abdominal respiration, thoracic respiration is managed by intercostal muscles innervated by intercostal nerves, while abdominal respiration comes from the diaphragm contraction. The phrenic nerve consists of cervical 3, 4, and 5, with cervical 4 being the main component. After cervical spinal cord injury, the intercostal muscles are completely paralyzed, so the survival of the injured person depends largely on whether abdominal breathing survives. Injuries to cervical 1 and 2 often result in the death of the injured person at the scene. Injuries to necks 3 and 4 also often result in death from respiratory failure at an early age because of the effect on the phrenic nerve center. Even injuries below cervical 4-5 can produce respiratory dysfunction due to the spread of post-injury spinal cord edema, which affects the center, and only lower cervical spine injuries can preserve abdominal breathing. Due to the lack of respiratory muscle strength. Breathing is very laborious, so that the resistance of the respiratory tract increases accordingly, the respiratory secretions are not easy to discharge, prone to fall pneumonia, generally within a week can occur respiratory infections, smokers are more in advance of the occurrence of the result is that the injured person due to respiratory infections are difficult to control or sputum blockage of the trachea due to asphyxiation and death. Tracheotomy can reduce the respiratory dead space, timely exhalation of respiratory secretions, the installation of ventilator for assisted breathing, but also through the trachea to give drugs; however, tracheotomy for the care of the composition of a great deal of difficulty, therefore, when to make tracheotomy the most opportune has not yet been decided, it is generally believed that the following patients should be made tracheotomy: (1) upper cervical spine injuries: (2) the emergence of respiratory failure: (3) respiratory infections sputum (3) Respiratory tract infections with sputum that cannot be easily coughed up: (4) Suffocation. Appropriate antibiotics and regular turning and patting of the back can help to control lung infections. 2, genitourinary tract infections and stones Due to the loss of sphincter function, the injured need to stay in the catheter for a long time because of urinary retention, easy to occur urinary tract infections and stones, and male patients will also occur parotitis. Preventive methods: (1) 2-3 weeks after the injury, the catheter is opened regularly, the rest of the time clamped closed, so that the bladder is full, to avoid atrophy of the bladder muscle, and to teach the casualty to massage pressure in the bladder area, emptying the urine, training into an autonomous bladder, and strive for the early removal of the catheter, which is particularly effective for cauda equina injury; (2) teach the patient to follow the strict aseptic practice, self (2) Teach patients to follow strict aseptic operation method and insert catheter to urinate at regular intervals; (3) For those who need to keep catheter for a long time and can not control the infection of urogenital tract, permanent suprapubic cystostomy can be done; (4) Drinking more water can prevent urinary tract stones, and drinking water twice a day is best to reach more than 3,000 ml. Infected people add antibiotics. 3, bedsores paraplegic patients long-term bedridden, loss of skin sensation, bone protrusion parts of the skin for a long time pressure on the mattress and bone protrusion between the neurotrophic changes, skin necrosis, known as bedsores. Decubitus ulcers most commonly occur in the sacral branch, the femur, skeletal crest, and heel, etc. They can be divided into four degrees. It can be divided into four degrees: (1) the first degree, skin redness, surrounding edema; (2) the second degree, skin blisters, purple-black color, there is a superficial skin necrosis, so there is a shallow second degree and deep second degree; (3) the third degree, the skin necrosis of the whole layer; (4) the fourth degree, the scope of necrosis deep to the ligament and bone. Huge decubitus ulcers ooze large amounts of body fluids daily, consume protein, and are the gateway for infections to enter, and the patient can die of exhaustion or sepsis and selfishness. Decubitus ulcers are the consequence of improper care and can be avoided. Prevention methods are: (1) mattress flat and soft, available air mattress bed: keep the skin clean and dry; (2) turn over every 2-3 hours, day and night adhere to; (3) on the part of the bone prominence daily scrubbing with 50% alcohol, talcum powder massage; (4) superficial bedsores can be baked with infrared lamps, but be aware of the occurrence of accumulation of secondary burns; (5) depth of bedsores should be cut out of necrotic tissues, change the dressings diligently; (6) Inflammation control, when the granulation is fresh, can be used for transfer flap suture. 4, body temperature dysregulation after cervical spinal cord injury, autonomic nervous system dysfunction, the skin below the injury plane can not sweat, the loss of regulation of temperature changes and adaptability, often prone to hyperthermia, up to 40 degrees or more. Treatment: (1) place the patient in the room with air conditioning; (2) physical cooling, such as ice packs, ice water enema, alcohol bath; (3) drug therapy, infusion and hibernation drugs. Pathology: According to the site or degree of injury: (1) Spinal cord concussion: Similar to concussion, spinal cord concussion is the mildest form of spinal cord injury. Flaccid paralysis occurs immediately after a strong shock to the spinal cord, with total loss of sensation, movement, reflexes, and sphincter function below the level of injury. Because there is no pathologic change in the histomorphology, it is only a temporary inhibition of function, which can be fully recovered within a few minutes or hours. (2) Spinal cord contusion and hemorrhage: Substantial destruction of the spinal cord. Although the spinal cord is intact, there may be hemorrhage, edema, destruction of nerve cells, and disruption of nerve conduction fibers within the spinal cord. The degree of spinal cord contusion varies greatly, from a small amount of edema and punctate hemorrhage in mild cases to patches of contusion and hemorrhage in severe cases, with softening of the spinal cord and formation of scarring, so the prognosis is extremely different. (3) Spinal cord rupture: The continuity of the spinal cord is interrupted, either completely or incompletely, and incompletely is often accompanied by contusion, also known as contusion injury. There is no hope of recovery after spinal cord rupture and the prognosis is poor. (4) Spinal cord compression: displaced fracture, broken bone fragments and broken intervertebral discs squeezed into the spinal canal can directly compress the spinal cord, and the wrinkled ligamentum flavum and rapidly formed hematoma can also compress the spinal cord, resulting in a series of pathological changes in the spinal cord injury. The function of spinal cord can be partially or completely restored after timely removal of the compression; if the compression time is too long, the spinal cord will be softened, atrophied or scarred due to the blood circulation obstacle, then the paralysis will be difficult to be restored. (5) Cauda equina injury: Fractures and dislocations below the 2nd lumbar vertebra can cause cauda equina injury, which is manifested as flaccid paralysis below the injury level. It is rare for the cauda equina to be completely severed. In addition, a variety of more serious spinal cord injury can occur immediately after the injury plane below the flaccid paralysis, which is the loss of high-level central control of a pathophysiological phenomenon, called spinal shock. 2 ~ 4 weeks after this phenomenon can be based on the degree of substantial damage to the spinal cord, and spastic paralysis occurs to varying degrees below the level of injury. Therefore, spinal shock and spinal cord shock are two completely different concepts. Segmental characteristics: As the signs and symptoms of spinal cord injury vary from segment to segment, the segment of spinal cord injury can be determined from the characteristics of spinal cord injury. 1, the upper cervical segment (cervical 1-4) injury cervical fractures account for 10% of spinal fractures. But cervical spinal cord, especially the high cervical segment with brain stem injury has a high mortality rate, which can account for 60% of the mortality rate of spinal cord injury. Upper cervical cord injury is spastic paralysis of the limbs. Because of the phrenic nerve center in the cervical 2-4 segments, no matter direct injury or adjacent to the lower cervical spinal cord contusion edema wave can cause diaphragmatic paralysis, dyspnea, coughing weakness, muffled pronunciation. 2, lower cervical segment (cervical 5-8) injury, tetraplegia, upper limb distal numbness and weakness, muscle atrophy, tendon reflexes decreased or disappeared, the performance of the lower motor stretch meridian paralysis; double lower limb is upper motor neuron paralysis. Increased muscle tone, hyperreflexia of knee and ankle, and positive pathological reflexes. Sensory loss below the plane of the injured segment was accompanied by sphincter dysfunction, and the reflexes of the bladder and the overall reflexes were obvious in about 7-8 weeks after the injury. 3, thoracic segment (thoracic 1-12) injury due to the thoracic spinal canal is narrower, spinal cord injury is mostly complete, the two lower limbs are spastic paraplegia and injury below the plane of sensory loss, middle and upper thoracic sprain due to partial paralysis of interosseous muscles can appear dyspnea. The abdominal wall reflexes are preserved or absent in lower thoracic segment damage, and if the middle thoracic segment is damaged horizontally, the upper abdominal wall reflexes (thoracic 7-8) are preserved, while the middle and lower abdominal wall reflexes are absent, which can be used as one of the signs for determining the injured segments. In the spinal shock phase, if the ocarina is injured above the 6th thoracic segment, the sympathetic block syndrome may appear, with loss of vascular tone, drop in blood pressure, bradycardia, and changes in body temperature in response to the outside world. After the spinal shock phase, there are general reflex, reflex cord, ejaculatory reflex and penile erection. 4, lumbar expansion (lumbar 1 a sacral 2) injury due to the thoracolumbar vertebral fracture opportunities, knee, ankle reflex and testicular reflex are lost. The abdominal wall reflex is not involved, because the spinal cord center loses control of the bladder and anal sphincter, defecation and urination disorders are more prominent than the light obvious. 5, spinal cord cone (sacral 3-5) and cauda equina injury spinal cord cone injury generally does not appear limb paralysis, can be seen gluteal muscle atrophy, anal reflex disappeared, perineum was saddle-like sensory loss. Spinal cord cone memory urinary center, after injury can not establish reflex bladder, rectal sphincter relaxation, urinary incontinence and sexual dysfunction. Lumbar vertebra 2 or less can only damage the cauda equina, the cauda equina in the spinal canal is more dispersed and the activity is big, not easy to damage all the damage, mostly incomplete damage, the symptoms on both sides are asymmetric, there can be severe pain and varying degrees of sensory disorders, sphincter and sexual dysfunction is not obvious.