Reinhold M, Knop C, Blauth M
Department of Trauma Surgery and Sports Medicine, Innsbruck Medical University, 6020, Innsbruck, Anichstrasse 35, Austria.
Arch Orthop Trauma Surg. 2006 Nov;126(9):624-30. doi: 10.1007/s00402-005-0078-1. Epub 2005 Dec 6.
Case report of a patient treated surgically 2 months after sustaining a misdiagnosed acute traumatic lumbosacral dislocation is presented.
The aims is to report in full about an uncommon case of anterior traumatic L5-S1 spondylolisthesis treated successfully with combined posterior stabilization and anterior fusion.
Review of literature shows that traumatic lumbosacral dislocations and its treatment by open reduction and internal fixation are rare with only few well-documented case reports.
We report the case of a 37-year-old man, who sustained a work-related traumatic lumbosacral dislocation. The delayed diagnosis of traumatic L5-S1 spondylolisthesis was initially missed and first treated, when the patient was transferred to the author's institution because of persistent neurological deficits. In the following the patient was successfully reduced and stabilized with posterior internal fixation and anterior interbody fusion. This case is documented in detail with radiographs, CT and MRI scans, as well as clinical pictures.
At a 1.5-year follow-up complete fusion was achieved. The patient returned to work on the same job before injury, ambulating pain-free with a good subjective back-function and no limitations carrying out his recreational activities. At follow-up he had persistent sensible S1 nerve root deficits (ASIA grade E).
Traumatic lumbosacral spondylolisthesis is a rare injury pattern. Its diagnosis can be missed initially, therefore computed tomography with biplanar reconstructions is mandatory in addition to good-quality conventional radiographs to plan and carry out such challenging management problems successfully. Surgical treatment for reduction, stabilization and interbody fusion is the method of choice.
本文报告一例患者，其在遭受误诊的急性创伤性腰骶部脱位2个月后接受了手术治疗。
全面报告一例罕见的前创伤性L5-S1椎体滑脱病例，该病例通过后路稳定和前路融合联合治疗获得成功。
文献回顾显示，创伤性腰骶部脱位及其切开复位内固定治疗较为罕见，仅有少数记录良好的病例报告。
我们报告一例37岁男性患者，其遭受与工作相关的创伤性腰骶部脱位。最初漏诊了创伤性L5-S1椎体滑脱的延迟诊断，当患者因持续的神经功能缺损转至作者所在机构时才首次接受治疗。随后，患者通过后路内固定和前路椎间融合成功复位并稳定。该病例通过X线片、CT和MRI扫描以及临床图片进行了详细记录。
在1.5年的随访中实现了完全融合。患者恢复了受伤前的相同工作，行走时无疼痛，主观腰部功能良好，进行娱乐活动无限制。随访时他仍有持续的S1神经根感觉功能缺损（ASIA E级）。
创伤性腰骶部椎体滑脱是一种罕见的损伤模式。其诊断最初可能被漏诊，因此除了高质量的传统X线片外，还必须进行双平面重建的计算机断层扫描，以成功规划和处理此类具有挑战性的管理问题。手术复位、稳定和椎间融合是首选治疗方法。
