kuliah spine
TRANSCRIPT
-
7/24/2019 Kuliah Spine
1/71
Trauma
Medula Spinalis
Dr.Dasa Sariadi Sp.BS., M.Kes
Departement of Neurosurgery
Gunung Jati Hospital
-
7/24/2019 Kuliah Spine
2/71
Insidensi (USA) :
8000 10.000 kasus baru per
tahun angka cacat tinggi
20 rb 00 rb pasien parap!egi
karena trau"a "edu!a spina!is
8 # !aki$!aki
-
7/24/2019 Kuliah Spine
3/71
Insidensi :A"erika: %0 kasus & 1 'uta ppu!asi !ebih
kurang 10.000 kasus& tahun
Indnesia: be!u" ada data *ang akurat
+andung (,S-S) : tahun 2002 terdapat % kasus(2# dari se!uruh trau"a)
/rea!ensi:A"erika: 21$0 kasus& 1 'uta ppu!asi
(183.000$203.000 kasus)
-
7/24/2019 Kuliah Spine
4/71
Anatomy(1)
4ertebra! c!u"n
arranged in 5ie
regins : cerica! 12
thracic
!u"bar sacra!and % ccc*gea!.
-
7/24/2019 Kuliah Spine
5/71
Anatomy(2)
4ertebrae
cnsists 5 :
A ertebra! bd*
A ertebra! (neura!)
arch
Seen prcesses
-
7/24/2019 Kuliah Spine
6/71
Anatomy(3)
Spina! crd It is prtected b* the ertebrae and their
assciated !iga"ents and "usc!es thespina! "eninges and the 6S7.
9tends 5r" the 5ra"en "agnu" in theccipita! bne t the 2 ertebra! !ee!
;hirt*$ne pairs 5 spina! neres areattached t the spina! crd : 8 cerica! 12thracic !u"bar sacra! and 1ccc*gea!.
-
7/24/2019 Kuliah Spine
7/71
-
7/24/2019 Kuliah Spine
8/71
-
7/24/2019 Kuliah Spine
9/71
Anatomy(4)
;he drsa! rts
5 spina! neres
cntain a55erent(r sensr*)
5ibers.
;he entra! rts
5 spina! nerescntain e55erent
(r "tr) 5ibers.
-
7/24/2019 Kuliah Spine
10/71
-
7/24/2019 Kuliah Spine
11/71
/A;-?/-@SI??I (1)
-
7/24/2019 Kuliah Spine
12/71
/A;-?/-@SI??I (2)
-
7/24/2019 Kuliah Spine
13/71
/A;-?/-@SI??I
-
7/24/2019 Kuliah Spine
14/71
/enanganan Inisia!
I
-
7/24/2019 Kuliah Spine
15/71
-
7/24/2019 Kuliah Spine
16/71
g$,!!ing techniDue
-
7/24/2019 Kuliah Spine
17/71
Patient immobilised on a rigidspinal board
-
7/24/2019 Kuliah Spine
18/71
7ungsina! :
A E 6"p!ete para!*sis
+ E Sensr* n!*
6 E
-
7/24/2019 Kuliah Spine
19/71
Sindr"a =!inikMotorik Sensorik
Centralcordsyndrome
Kelemahan extsuperior lebih
berat
Bermacam-macam,dibawah lesi
Myelopati retensi urin
Anterior
cordsyndrome
!araple"i
bilateral
#is sensory loss nyeri
suhu hilan", Kol postinta$ (two point dis,
position, deep press)
Posterior
cord syndr.
!aresis (%) !ain & parestisis
(burnin")
Brown-Squaredsyndrome
'psi-lat paralysisbelow lesion
Kontra-lat #is sensoryloss, ipsi-lat prop ibration hilan"
-
7/24/2019 Kuliah Spine
20/71
-
7/24/2019 Kuliah Spine
21/71
At!ant$ccipita! dis!catin
/eran uta"a : !iga"entu"
Ceur!gi : bisa intak
;erapi : kntrersia! : perati5 atau
i"bi!isasi (% 12 bu!an)
-
7/24/2019 Kuliah Spine
22/71
-
7/24/2019 Kuliah Spine
23/71
6$1 5racture
7raktur di arkus 6$1 E >e55ersn
7racture
-
7/24/2019 Kuliah Spine
24/71
6$2 5raktur : -ang"anHs 7racture
7raktur di pars inter$articu!aris
(isth"us) di pedike! 6$2 anterir sub!ukssasi 6$2 n 6$3
-
7/24/2019 Kuliah Spine
25/71
-
7/24/2019 Kuliah Spine
26/71
-
7/24/2019 Kuliah Spine
27/71
?dntid 7racture
;rau"an*a kuat
-
7/24/2019 Kuliah Spine
28/71
-
7/24/2019 Kuliah Spine
29/71
-
7/24/2019 Kuliah Spine
30/71
63 6
Sub!u9atin !cked 5acets
Sub!u9atin J 3 "" angu!atin J 11K
E instabi!itas ;erapi : traksi bi!a gaga! perati5
;eardrp 5racture : harus dicari ke!ainan*ang !ain bi!a tak stabi! : perati5
-*per5!e9in Sprain
6!a* she!er 5racture : au!si prsesusspinsus stabi!
-
7/24/2019 Kuliah Spine
31/71
S6IL?,A (Spina! 6rd In'ur*Githut ,adigraphic
Abnr"a!it*)
+an*ak di anak karena !iga"en
"asih e!astis dan 5acet 'int
"endatar
-
7/24/2019 Kuliah Spine
32/71
;hrac!u"bar spine 5racture
Instabi!it* : three c!u"n "de!
Anterior column Anterior VB + ALL
Middle column Posterior VB + PLL
Posterior column Posterior arc + L!
-
7/24/2019 Kuliah Spine
33/71
-
7/24/2019 Kuliah Spine
34/71
-
7/24/2019 Kuliah Spine
35/71
-
7/24/2019 Kuliah Spine
36/71
-
7/24/2019 Kuliah Spine
37/71
-
7/24/2019 Kuliah Spine
38/71
-
7/24/2019 Kuliah Spine
39/71
-
7/24/2019 Kuliah Spine
40/71
-
7/24/2019 Kuliah Spine
41/71
S/ICA S-?6=
-iptensi :
Sist!ik M 80 ""-g
+radikardia nadi M 0 ka!i&"enit 4asdi!atasi
/arese hingga p!egia
angguan 5ungsi neur!gi se"entara
-
7/24/2019 Kuliah Spine
42/71
SI =?
-
7/24/2019 Kuliah Spine
43/71
SI IC=?
-
7/24/2019 Kuliah Spine
44/71
;I/ SI IC=?
-
7/24/2019 Kuliah Spine
45/71
6entra! crd s*ndr"e
/art 5 3 "ain
tracts in!ed
n bth side Upper !i"bs
"re a55ected
than !Ger
!i"bs
+ S d d
-
7/24/2019 Kuliah Spine
46/71
+rGn$SeDuard s*ndr"e
?ne side 5
crd a55ected
ss 5 "tr5unctin and
psitin sense
n !esin side
ss 5 painsensatin n
ppsite side
A t i d d
-
7/24/2019 Kuliah Spine
47/71
Anterir crd s*ndr"e
+i!atera! !ss 5
"tr 5unctin
and painsensatin be!G
!esin
/sitin sense
presered
-
7/24/2019 Kuliah Spine
48/71
/sterir crd s*ndr"e
/sitin sense
!ss be!G
!esin
-
7/24/2019 Kuliah Spine
49/71
?=ASI 6F,A
-
7/24/2019 Kuliah Spine
50/71
F,A>A; 6F,A
-
7/24/2019 Kuliah Spine
51/71
/
-
7/24/2019 Kuliah Spine
52/71
/
-
7/24/2019 Kuliah Spine
53/71
/
-
7/24/2019 Kuliah Spine
54/71
/
-
7/24/2019 Kuliah Spine
55/71
The Lateral Cervical Spine X-Ray
The LateralCervical Spine X-Ray
http://www.trauma.org/spine/images/cspineLAT.jpg -
7/24/2019 Kuliah Spine
56/71
http://www.trauma.org/spine/images/cspinealign.jpg -
7/24/2019 Kuliah Spine
57/71
http://www.trauma.org/spine/images/cspine-unifacet.jpg -
7/24/2019 Kuliah Spine
58/71
http://www.trauma.org/spine/images/cspine-bifacet.jpg -
7/24/2019 Kuliah Spine
59/71
http://www.trauma.org/spine/images/cspine-teardrop.jpg -
7/24/2019 Kuliah Spine
60/71
6; Scan
/ada !ee! tu!ang *ang abnr"a! (5t
p!s)
Sesuai !ee! de5isit neur!gi /tngan tipis 1$3 "" pada te"pat
*ang dicurigai
=adang$kadang "e"butuhkanpe"eriksaan dengan kntras
-
7/24/2019 Kuliah Spine
61/71
6; Scan "ergensi
esi ink"p!it atau dengan ge'a!aneur!gi *ang "e"buruk
ee! 5raktur berbeda dengan !ee! de5isit
neur!gi ;u!ang ter!ihat nr"a! tetapi k!inis
"e"buruk. 6; Scan untuk "en*ingkirkan
'aringan !unak *ang "enekan crdsehingga per!u dek"presi segera.
-
7/24/2019 Kuliah Spine
62/71
Traumatic Fracture Dislocatio L1
Post Pedicle screw i!ation " Laminectomy
-
7/24/2019 Kuliah Spine
63/71
Fracture # Dislocatio C$-%
&C' Stenosis
Lateral mass platin(Pre )P
-
7/24/2019 Kuliah Spine
64/71
-
7/24/2019 Kuliah Spine
65/71
-
7/24/2019 Kuliah Spine
66/71
-
7/24/2019 Kuliah Spine
67/71
ICFI=ASI ?/,A;I7 (1)
SI =?
-
7/24/2019 Kuliah Spine
68/71
ICFI=ASI ?/,A;I7 (2)
SI IC=?
-
7/24/2019 Kuliah Spine
69/71
ICFI=ASI ?/,ASI
-
7/24/2019 Kuliah Spine
70/71
/,?C?SIS
PerbaikanPerbaikan PerbaikanPerbaikandgn Metyldgn Metylprednisolonprednisolon
!rankle!rankle"#B"#B
$%$% &&%&&%
!rankle!rankle'#D'#D
()%()% *(%*(%
-
7/24/2019 Kuliah Spine
71/71
;,I