TRAUMA TULANG BELAKANG REFERAT
DISUSUN OLEH: PEM$IM$IN: ERVA ER VAN N ADITYA PUTRA CHAFI D|071071401 9 RISA NTOSO& SP!$& SP!OT 'K( RISANTOSO& Y U S U F R I Z A L M A H E N D RA | 1 0 5 0 7 0 1 0 0DR! 1 1 1 0T%UK 62 ANAK AUN DERISNA C!S| SPINE 1 0 5 0 7 0 1 0 7 1 1 1DR! 0 2 2 RAKHMAD A DITYA HERMA"AN Y U S T I A I K A "A R D H A N I | 1 1 5 0 7 0 1 0 0 1 1 1 0 4 5
DEFINISI Trauma tulang belakang adalah trauma mengenai cervicalis, vertebralis dan lumbalis akibat trauma !atuh dari ketinggian, ketinggian, kecelakaan kecelakaan lalu lintas, kecelakaan kecelakaan "lah raga, dan sebagain#a #ang da$at men#ebabkan %raktur atau $ergeseran satu atau lebih tulang vertebra sehingga mengakibatkan de&sit neur"l"gi
ANATOMI T)*+, T)*+,$.*+/+,- '..3+.( ++*+ )*+,+,.+,8+,- + *.. +;+ /. .*+,-/+,-+, +,- . + << )*+,-: 7 3)+ )*+,- ./+*& 12 3)+ )*+,=+/+*& 5 3)+ )*+,- *)3+*& 5 3)+ )*+,- +>+*! D/) ,...3+*. .);+/+, ;.,-)3),- +,++ )+ /=;) ..3+.! S. == *-+.,) .3.,)/ 8+8++, 3++, '+*-.,( )*+,- 3.*+/+,- +, .),-/,/+, =3*+ ..3+.! D +*+ )),+, )*+,- ..3) .+,-/+ ;)*+ +,-/++, ++?@++?& +,- 3*+ .8+ >..+ )*+,- 3.*+/+,+/+ +/+, .;.,-+) ++?@++? ++?@++? ..3)!
EPIDEMIOLO I
I,., >..+ )*+,- 3.*+/+,- A./+ S./+ ++*+ ./+ 40 /+) ;. 8)+ ;.,))/& ++) ./+ 12!500 ;+.,& ;. +), 3.++/+, ++ National Spinal Cord Injury Basis Data !
•
•
P./++, + 3.3+-+ ;.,.*+, .,),8)//+, 3++ 8)*+ =+,- A./+ S./+ ); ;++ +), 2010 .,-+, >..+ )*+,- 3.*+/+,- ++*+ ./+ 276!000 =+,- .,-+, /++, 240&000@ <<7&000 .,-+, )+ ++@++ 42 +), 'NSCISC& D3) ++* =+,- .,-+, >..+ )*+,- 3.*+/+,- .8+/ +), 2015& 64B ++*+ 2015(! ,=,@;+,/ ;)& 2..+ )*+,- 3.*+/+,-! S.>++ /..*))+,& #0&7B ;=;)*+ + >..+ +,- *+;=/+, ++*+ *+/@*+/
ETIOLOI K.>.*+/++, /.,+++, 3.==! '<5B ( %+) + /.,--+, ' 8+) .);+/+, ;.,.3+3 )*+,3.*+/+,- ..,- ;++ )+ 65 +),& +) ( T,+/ /./.++, ' ./+ 15 B& ;+*,- 3+,+/ /+.,+/+, *)/+ .3+/ ;+)( O*++-+ +, >..+ ./.+ ' 9 B( A*/==* P.,+/ ' . /+,/.& +& =.;== +, ++,- ))
FAKTOR RESIKO L+/@*+/ '#0B( M.*/ ;.*+/) 3./= ' .& M.,.*+ /. +*+ + .*+*) +,-/+* ++) 3.+, =*++-+ +,;+ .,-.,+/+, ;.+*++, /..*+++, +,- .;+( M.*/ -+,--)+, )*+,- ++) ., '.& + ++) =.=;==(
KLASIFIKASI TRAUMA TULAN $ELAKAN 1949
N>=**
2 3+> -=); =? ,8).: +3*. +, ),+3*.
196<
H=*=
Signifcance o the posterior ligament complex or stability o the spine
197<
L=)
C*+G>+=, ),- .. >=*), >=,>.;: V..3+* 3=. +, = = =? *+.+* +.
19#<
D.,
Three column theory ! C=,>.; =? .
R=@C+**.
*. >=*), + +. = 3. =, , +=, = . ;=.= *-+.,=) >=;*. ?= +>). ;,+* ,+3* I,+3* >+). 3 ,8) = . ,.)+* ,-
19#4
POSTERIOR
ANTERIOR MIDDLE
' ()LUMN* +EN-* (LA**-F-(AT-)N.
KLASIFIKASI D*=/+ +*+,= =/;+ '+*+,= =>>;+* *=>+=,( F+/) +*+ 'C@1( R=+ )3*)+=, + C@1 F+/) +/'C@2( F+/) *=>+=, ' C@< +;+ C@7( F+/) ..3+ =+/+* ' T@1 +;+ T@10( F+/) +.+ =+/=*)3+* 'T@11 +;+ L@1( ?+/) *)3+*
MEKANISME CEDERA TULAN $ELAKAN
'+( 8+) ;++ /.;+*+ ++) 3+-+, *..J '3( ;)/)*+, ;++ +& +,- .+/+ *.. 3.;../.,
TIPE PERESERAN PADA TULAN $ELAKAN H;../., 'K=3,+ +/ +, ./.,( F*./ P.-..+, +/+* '/=;.( F*./& /=;. +, +/ ;=.= F*./ +,- -+3),-/+, .,-+, =+ +, ;.),+, T+,*+ ==,+*!
DIANOSIS AB( /ist"r# 0emeriksaan Fisik 0emeriksaan Neur"l"gis
PRIMARY SURVEY 'A$C( < /.),-/,+, =/ +,- +;+ 3)* ;++ +)+ )*+,- 3.*+/+,-: S=/ H;==*./& +,+ .,-+, +//+& /=,/ ;.?. +, ;=.,! S=/ N.)=-.,/ ),>)* /+.,+ /.)+/+, ;+ ;++ )*+,- 3.*+/+,-& ;.3)*) ++ ;.?. *++ +, .,-+/3+/+, ;=., ,+), +/ .;.,-+) ;.,,-/++, .,) 8+,),'.=,+/( S;,+* =>/ .8+ /./+ )*+,- 3.*+/+,- )+/ +/3+ + +)+! $+-+, )3) +,- 3./++, .,-+,
HISTORY S.+; ;+., .,-+, +)+ );)* ++ >*+/)*+& >.+ /.;+*+& ++) /.*+,-+, /.+++, ;+) >)-+ ++,+ +)+ )*+,- 3.*+/+,- +;+ .3)/ .3+*/,+
PEMERIKSAAN FISIK INSPEKSI& PALPASI LEHER PUNUN *+/)/+, *=-@=**
PEMERIKSAAN NEUROLOIS E+*)+ .,=/ E+*)+ ==/ E+*)+ ../ $)*3=>+.,=)
70B ;+., +/ ),>)* .G ,.)=*=-
PEMERIKSAAN NEUROLOIS
MAIN PRO$LEMS F, : 12 -nstabilit# 32 Neur"l"gical e&cit
PEMERIKSAAN PENUN%AN 12 F)T) 45RA6
:
),)/ .*+ ++,+ ?+/) ++);), ;.-..+, ;++ ..3+& .+ ),)/ .;.*+/+, ?+ +, ,-/+ *. )*+,-! H+* +,- +) 3+>+ ;++ @+: '1( $++,-+, 8+,-+, *),+/! '2( T; .3+*,+ /=./ .3+-+ +/3+ .+/ ;.=.) ++) 3=./+,/ ++) 8)-+ =+! '<( T=3)/)*+ ++ +/,+ +. ?+>=,!
32 ("m$uteri7ed T"m"gra$h# :
P../++, ..3+ .,-+, CT >+, *+/)/+, .,-+, .*+ +,@+, +,+*/+, CT >+,! CT .*/ )+*+ +,- 3+/ + .*.., ;=.=!
'2 Magnetic Res"nance -maging
+3++, +,- +/+, +*/+, MRI ++*+ -+3++, < ., ! MRI .,- -),+/+, ),)/ .,-.+) /.)+/+, 8+,-+, *),+/ ;++ *-+., +, >) ,...3+* +, .,*+ >..+ .)**+ ;,+*!
PENATALAKSANAAN
TU%UAN M+,+,+,>. ?),- ,.)=*=- M,+*+ +;+/ + /=;. ++? S+3*+ )*+,- 3.*+/+,R.+3*+ ;+.,
120rinsi$ umum
P//+, .*+*) /.),-/,+, ++,+ >.. .)*+ ;,+*
•.
M.,>.-+ .8+,+ >..+ /.)+
•.
"+;++ +/+, +,+ +,- .,),8)//+, 8.8+ *,+,-
•.
L+/)/+, .+*)+ +, .+3*+
•.
32Tindakan Adakan im"bilisasi di tem$at ke!adian +dasar $a$an., di$errtahankan sam$ai terbukti tidak ada cedera
•.
)$timalisasi %aal AB( !alan $erna%asan, dan $eredaran darah
•.
•.
L"g r"ll bila memindahkan $asien
•.
0enanganan kelainan #ang lebih urgen
•.
K"nsultasi ke ahli
na$as,
P../++, ,.)=*=-/ ),)/ .,.,)/+, .;+ *.
•
•
P../++, +=*=-/ '/++,- ;.*)/+,(
T,+/+, 3.+ './=;.& .;=& ++) +3*+(
•
•
P.,>.-++, ;.,)* I*.) ;++*/
=,. *+3),-
P.,)* /.*);)+, /+,),- /. /+..
Stable injuries +3*+ )*+,3.*+/+,- .,--),+/+, G >=**+ ++) *)3+ 3+>.J ;../++, +-,=/ .,-+, CT@>+,
Unstable injuries *+/)/+, ,+/+, ),)/ .,-)+,- *=/+ +, )3*)/+ .,-+, .,.)+/+, ;=) )3)
KOMPLIKASI D.G ,.)=*=-& .)++ .G .,= R./= ,-- +;+ P+>+ =;.+: ;=.& ./)3)& ;,.)=,+& )*/) +/3+ ./+,+,& .3=* ;)*=& ,?./
PRONOSIS P+., .,-+, +)+ 3.*+/+,- /=;* 3.;.*)+,.3) /)+,- + 5B! %/+ .8+ ;++* /=;* +*+ +/) 72 8+ ..*+ +)+& ;.*)+,;.3+/+, ++*+ ,=*! P=-,= +)+ 3.*+/+,- ,/=;* *.3 3+/! %/+ ?),- .,= + ++& ;.*)+,- ;+., ),)/ +;+ 3.8+*+, /.3+* *.3 + 50B
