{"id":7951,"date":"2026-01-04T18:57:55","date_gmt":"2026-01-04T17:57:55","guid":{"rendered":"https:\/\/kineaphp.fr\/?p=7951"},"modified":"2026-01-04T18:57:55","modified_gmt":"2026-01-04T17:57:55","slug":"blesse-medullaire-les-complications","status":"publish","type":"post","link":"https:\/\/kineaphp.fr\/?p=7951","title":{"rendered":"Bless\u00e9 m\u00e9dullaire : les complications"},"content":{"rendered":"\n<h3 class=\"wp-block-heading\">Hypotention orthostatique<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>80% des parapl\u00e9giques<\/li>\n\n\n\n<li>Mettre bas de contention et gaine abdominale en cas de verticalisation<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Hyper-r\u00e9flexie autonome (HRA)<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patient avec l\u00e9sion m\u00e9dullaire sup\u00e9rieur ou \u00e9gale \u00e0 T6<\/li>\n\n\n\n<li>D\u00e9charge sympathique \u00e0 cause d\u2019un stimuli nociceptif sous-l\u00e9sionnel : augmentation brutale de la tension art\u00e9rielle, malaise, c\u00e9phal\u00e9e, sueurs, hyperthermie<\/li>\n\n\n\n<li>Urgence th\u00e9rapeutique : appeler m\u00e9decin<\/li>\n\n\n\n<li>Faire baisser TA : retirer les contention, baisser les jambes<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Accidents thrombo-embolique<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Thromboses veineuses profondes : fr\u00e9quentes dans les premiers mois<\/li>\n\n\n\n<li>Embolie pulmonaire<\/li>\n\n\n\n<li>Pr\u00e9vention : traitement anticoagulant, bas de contention<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Spasticit\u00e9<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Lib\u00e9ration des r\u00e9flexes spinaux par manque d\u2019inhibition corticale<\/li>\n\n\n\n<li>Hypertonie spastique<\/li>\n\n\n\n<li>Cons\u00e9quences : raideur, r\u00e9tractions articulaires, attitudes vicieuses, majoration du risque d\u2019escarre<\/li>\n\n\n\n<li>Spasticit\u00e9 peut \u00eatre major\u00e9e par des \u00e9pines irritatives<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Les \u00e9pines irritatives<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Probl\u00e8mes urinaires : infections urinaires, lithiases<\/li>\n\n\n\n<li>Escarre, plaie, ongles incarn\u00e9<\/li>\n\n\n\n<li>Constipation, f\u00e9calome<\/li>\n\n\n\n<li>Paraost\u00e9oarthropathies\/ost\u00e9omes<\/li>\n\n\n\n<li>TVP<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Douleurs<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Douleurs neuropathiques sous-l\u00e9sionnelles : sensations de br\u00fblure, d\u00e9charges \u00e9lectriques, piq\u00fbres<\/li>\n\n\n\n<li>Douleurs d\u2019\u00e9paules dues \u00e0 la surutilisation des MS<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Troubles v\u00e9sico-sphinct\u00e9riens<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Dyssynergie v\u00e9sico-sphinct\u00e9rienne, r\u00e9tention<\/li>\n\n\n\n<li>Hyperactivit\u00e9 d\u00e9trusorienne : incontinence sur urgenturie, risque de reflux v\u00e9sico-ur\u00e9tal<\/li>\n\n\n\n<li>Risque de complications infectieuses et insuffisance r\u00e9nale<\/li>\n\n\n\n<li>Sondage : minimum 5 par jour (autonomie parfois possible \u00e0 partir de C6)<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Troubles ano-rectaux<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Constipation fr\u00e9quente : 45 \u00e0 95%<\/li>\n\n\n\n<li>Paralysie motrice des abdominaux<\/li>\n\n\n\n<li>Dyssynergie ano-rectale<\/li>\n\n\n\n<li>Traitement par laxatifs, adaptation alimentaire, irrigation colique trans-anale<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Troubles g\u00e9nito-sexuels<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Dys\u00e9rection, dys\u00e9jaculation, dysorgasmie<\/li>\n\n\n\n<li>Traitement par m\u00e9dicament, vacuum, proth\u00e8se p\u00e9nienne, injection intra-caverneuses<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Escarres<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>L\u00e9sion cutan\u00e9e isch\u00e9mique li\u00e9e \u00e0 une compression prolong\u00e9e des tissus mous entre un plan dur et les saillies osseuses<\/li>\n\n\n\n<li>4 stades : \u00e9ryth\u00e8me (rougeur), d\u00e9s\u00e9pidermisation, plaque de n\u00e9crose, perte cutan\u00e9e profonde<\/li>\n\n\n\n<li>Pr\u00e9vention : matelas adapt\u00e9, alternance position au lit, soul\u00e8vement par push-up toutes les 15mn au fauteuil, observation r\u00e9guli\u00e8re de l\u2019\u00e9tat cutan\u00e9e<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Para-ost\u00e9o-arthropathies neurog\u00e8ne (POAN)<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ossification de localisation anormale se d\u00e9veloppant dans le tissus conjonctif des parties molles p\u00e9riarticulaires (ost\u00e9ome)<\/li>\n\n\n\n<li>Toujours en sous-l\u00e9sionnel, au voisinage des grosses articulations (hanche, genou, coude, \u00e9paule)<\/li>\n\n\n\n<li>Clinique : douleur, limitation amplitude articulaire (ankylose compl\u00e8te), tum\u00e9faction<\/li>\n\n\n\n<li>Pr\u00e9vention : kin\u00e9sith\u00e9rapie pr\u00e9coce<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Respiratoire<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>L\u00e9sion au-dessus de C4 : paralysie phr\u00e9nique impose une assistance ventilatoire<\/li>\n\n\n\n<li>L\u00e9sion entre C4 et moelle dorsale haute : autonomie respiratoire avec fonction diaphragmatique pr\u00e9serv\u00e9e, mais pr\u00e9caire car paralysie des muscles intercostaux et abdominaux<\/li>\n\n\n\n<li>Perte des muscles expiratoires : toux inefficace et risque d\u2019encombrement bronchique<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Synringomy\u00e9lie<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>D\u00e9veloppement d\u2019une cavit\u00e9 remplie de liquide c\u00e9phalo-spinal \u00e0 l\u2019int\u00e9rieur de la moelle<\/li>\n\n\n\n<li>Peut menacer une perte fonctionnelle d\u2019un ou plusieurs m\u00e9tam\u00e8res<\/li>\n\n\n\n<li>Toute modification de l\u2019examen neurologique doit y faire penser ++<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Ost\u00e9oporose<\/h3>\n\n\n\n<p>Se d\u00e9veloppe rapidement en sous-l\u00e9sionnel : diminution des contraintes en pesanteurs et en sollicitation, diminution du d\u00e9bit sanguin osseux<\/p>\n\n\n\n<p>Risque de fractures spontan\u00e9es<\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Hypotention orthostatique Hyper-r\u00e9flexie autonome (HRA) Accidents thrombo-embolique Spasticit\u00e9 Les \u00e9pines irritatives Douleurs Troubles v\u00e9sico-sphinct\u00e9riens Troubles ano-rectaux Troubles g\u00e9nito-sexuels Escarres Para-ost\u00e9o-arthropathies neurog\u00e8ne (POAN) Respiratoire Synringomy\u00e9lie Ost\u00e9oporose Se d\u00e9veloppe rapidement en sous-l\u00e9sionnel : diminution des contraintes en&hellip;<\/p>\n<p class=\"more-link-wrapper\"><a href=\"https:\/\/kineaphp.fr\/?p=7951\" class=\"more-link\">Continue Reading<span class=\"screen-reader-text\"> \u00ab\u00a0Bless\u00e9 m\u00e9dullaire : les complications\u00a0\u00bb<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[406],"tags":[],"class_list":["post-7951","post","type-post","status-publish","format-standard","hentry","category-champ-neuro-atteinte-medullaire"],"_links":{"self":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/7951","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=7951"}],"version-history":[{"count":1,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/7951\/revisions"}],"predecessor-version":[{"id":7952,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/7951\/revisions\/7952"}],"wp:attachment":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=7951"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=7951"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=7951"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}