Cervical fracture and high paraplegia, complications must be prevented

The adverse effects of high-level paraplegia caused by cervical spine fracture on patients are immeasurable. After surgery, we must also be careful to prevent the occurrence of complications. Common complications include urinary tract infection, joint stiffness and deformity, bedsores, respiratory tract infection, etc.

1. Prevent urinary tract infection. Because of the need for long-term indwelling catheter due to urinary retention, urinary tract infection and stones are prone to occur.

Prevention methods: ① Strictly follow aseptic techniques when inserting the catheter and change the catheter once a week. ② Flush the bladder 1 to 2 times a day with normal saline, 3% boric acid solution or 0.1% to 0.05% furacilin solution. ③The catheter is opened every 4 hours to train the bladder to form an automatic bladder and avoid long-term bladder emptiness and contracture that reduces bladder capacity. ④ Encourage patients to drink more water, more than 3000 ml per day. ⑤ The catheter can be removed when the residual urine volume in the bladder is less than 100 ml. ⑥Use antibiotics to treat if there is infection. It is currently believed that the best way to prevent urinary tract infection and treat urinary retention is to not leave a urinary catheter and to use intermittent catheterization every 4 hours.

2. Prevention and treatment of joint stiffness and deformity . Due to limb paralysis or spasm, foot drop and hip adduction deformity often occur in the lower limbs, and joint stiffness often occurs. In addition, heterotopic ossification may occur around the hip joint. The prevention and treatment methods are daily passive movement and limb massage, placing the limb joints in functional positions, and using guards to support bedding to prevent compression of the toes and foot drop.

3. Prevent and treat bedsores. Paraplegic patients lose sensation in their skin and have poor local blood circulation. Long-term pressure on the skin over bony protuberances can easily lead to bedsores, which can cause infection and inflammatory exudate, and can spread deep into the bones to cause osteomyelitis. Bedsores are difficult to heal and can even lead to death due to massive consumption and infection. Prevention methods: ① Keep the mattress flat and soft, avoid contamination by urine and feces, clean it regularly and keep the skin dry. ② Turn over every two hours, day and night. ③Towards bone protrusions. For example, the sacrum, greater trochanter, heel, iliac crest, etc. should be protected with soft pads or air cushions. Scrub the area with 25% to 50% alcohol and massage with talcum powder every day. ④ If bedsores have occurred, physical therapy and ultraviolet irradiation can be performed, necrotic tissue should be cut off when changing the dressing, and some decomposing and organic drugs should be applied. When the inflammation is under control and the granulation tissue is fresh, a skin transfer is performed to close the wound.

4. Prevention and treatment of respiratory tract infections. Patients with high paraplegia have paralysis of the intercostal muscles, small lung capacity, and respiratory secretions are difficult to expel, making them prone to lung infections. The prevention and treatment method is to encourage turning over, coughing, massage the skin to help expectoration, and use a suction device to suck it out when necessary. Perform steam inhalation 2 to 3 times daily. If the secretions are thick and large in volume and the patient is unable to expel them, tracheotomy may be performed if necessary.