(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: External violence to the neck, through squeezing, pushing, pulling, and pressing in all directions, and collisions of the head, neck, shoulder, and back can damage the muscles, ligaments, and joint capsule of the neck, resulting in cervical fractures caused by vertebral joint instability. The patient in this case presented with numbness in the right hand, neck pain, restricted movement, and pins-and-needles pain symptoms due to injury to the head and neck from a car accident. The patient was admitted to the hospital and was immediately given surgical treatment. The patient recovered well after surgery.
Basic information】Male, 75 years old
Disease Type】Cervical fracture
Hospital】The First Hospital of China Medical University
Date of consultation】March 2021
Treatment plan】Surgery (cranial traction) + medication (Shujinjin and blood circulation tablets, compound thromboxane capsules, dog skin cream)
Treatment Period】25 days of hospitalization and 3 months of outpatient follow-up
Effectiveness】The patient was discharged from the hospital after successful surgery and no other complications.
I. Initial interview
Patient, male, 75 years old. He was injured in the head and neck and lower limbs in a car accident one hour ago, and felt numbness in his right hand, neck pain, limited movement, localized pins and needles pain, headache, dizziness, no nausea, vomiting, no unconsciousness, no abdominal pain, no bilateral numbness in the lower limbs, and came to the hospital urgently. The patient was given a physical examination, with blood visible on the face, normal presence of each physiological curvature of the spine, no scoliosis, pressure pain at the cervical spine, cervical spine limitation, flexor elbow muscle level 4-, extensor elbow muscle strength level 4-, flexor-extensor wrist muscle strength level 4-, left hand grip strength level 4-, right flexor elbow muscle level 4-, extensor elbow muscle strength level 4+, flexor-extensor wrist muscle strength level 4+, right hand grip strength level 4, left lower extremity muscle strength level 5, right lower extremity muscle strength level 5. CT examination of the neck was performed, and the results showed: fracture of the anterosuperior border of cervical 6 vertebrae, fracture of the right transverse process of cervical 7 with involvement of the superior articular process, and fusion deformity of cervical 4 and 5 vertebrae. Cervical ankylosis was negative, and Brudzins ki sign was negative. The preliminary diagnosis was “cervical fracture”.
II. Treatment process
After communication with the patient and his family, “skull traction” was performed immediately. The operation was smooth. After the operation, the patient was given intracranial drainage and a lateral cervical X-ray was taken at the bedside every hour. After the embedded joint protrusion was pulled apart, a soft pillow was placed under the patient’s shoulder to gradually straighten the neck, and then the weight of traction was reduced and changed to maintenance traction, and the patient was given Shujian and Blood-strengthening tablets and compound thromboxane capsules to relieve swelling and pain and activate blood stasis. The patient’s family was also instructed to keep the traction hook dry and clean. After 20 days of postoperative traction, the patient’s soft tissue injury had healed and the fracture was relatively stable, and the patient was given a metal brace for fixation. At the same time, as the patient’s systemic symptoms improved, he could stop using the blood-stasis-activating drugs.
III. Treatment effect
After surgery and medication, the patient’s mental status improved, and her diet, sleep and bowel movements were normal. Body survey: body temperature was 36.6℃, and the body temperature was not high. The fracture site of the cervical vertebra was gradually healed, and slight pain appeared in the neck, but it was tolerable. The patient was advised to apply topical dog skin ointment to relieve the local pain symptoms. Other symptoms of headache and dizziness were significantly improved, and there were no other complications. The patient had no other obvious discomfort and was discharged at the request of the patient and his family.
IV. Notes
The patient was discharged after her condition improved, and she came to the office with her family to express her gratitude, and I was especially happy for the patient. I advised the patient to follow the doctor’s prescription for medication after discharge and to come back to the hospital in one month to review the X-ray and CT of the neck, and to remove the metal brace depending on the healing of the cervical fracture. At the same time, pay attention to the daily warmth and the protection of the neck to prevent secondary injury. Special attention should be paid to prohibit the removal of the metal brace by oneself, and if there is any abnormality, promptly go to the hospital. After discharge from the hospital, attention should be paid to balanced nutrition and appropriate consumption of high protein and high vitamin foods, such as milk, beef, eggs, spinach, etc. Try to avoid spicy and stimulating foods, such as pepper and chili. In addition, attention should be paid to daily adherence to rehabilitation training.
V. Personal insight
Clinical treatment for cervical fracture dislocation is usually surgical, and it is easy to complicate infection if improper care is provided during the perioperative period. In this case, the patient’s surgery went smoothly and there was no serious postoperative infection, which was mainly related to wound drainage care and postural care, which reduced the wound exudate situation to a certain extent and avoided infection of the incision. In addition, strengthening rehabilitation training can also enhance the patient’s physical function, which is conducive to speeding up recovery, thus achieving the purpose of reducing postoperative complications and improving their quality of life.