Nourbakhsh Ali, Patil Shashikant, Vannemreddy Prasad, Smith Donald
Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA 71130, USA.
J Manipulative Physiol Ther. 2009 Sep;32(7):592-6. doi: 10.1016/j.jmpt.2009.08.009.
The purpose of this case is to describe noncontiguous fracture and dislocations of the thoracolumbosacral spine in a 23-year-old female driver with a 3-point seat belt restraint.
A 23-year-old woman presented to us after a motor vehicle accident while driving with a 3-point seat belt restraint. She was neurologically intact except for loss of motor function in the distribution of the L5 nerve root in the right lower limb. Computed tomography and magnetic resonance imaging showed fracture and dislocation of T3 with considerable retrolisthesis and complete anterolisthesis of L5 over the sacrum.
Both fractures were reduced and fixed with bone graft and instrumentation. She was discharged a month later without any further neurologic deterioration.
To our knowledge, this case is the first report in the literature of a seat belt safety restraint causing 2 noncontiguous fracture dislocations of the spine. Although the consensus is that seat belts can prevent most spine injuries, this case shows that the seat belt can be a contributor to spine injury. It shows that the shoulder-lap restraint can act as 2 fulcrums at the upper and lower bands causing 2 separate fracture dislocations. A thorough radiologic evaluation of the spine with respect to the clinical findings is mandatory in seat belt-restrained road traffic accidents cases.
本病例报告旨在描述一名23岁女性驾驶员在使用三点式安全带约束情况下发生的胸腰段脊柱非连续性骨折和脱位。
一名23岁女性在驾驶时发生机动车事故，事故发生时系着三点式安全带。除右下肢L5神经根分布区域运动功能丧失外，其神经功能完好。计算机断层扫描和磁共振成像显示T3骨折并脱位，伴有明显的椎体后移，L5相对于骶骨完全向前滑脱。
两处骨折均通过植骨和内固定进行复位。一个月后患者出院，未出现任何进一步的神经功能恶化。
据我们所知，本病例是文献中首例关于安全带安全约束导致脊柱两处非连续性骨折脱位的报告。尽管普遍认为安全带可预防大多数脊柱损伤，但本病例表明安全带也可能导致脊柱损伤。它表明肩带约束在上下束带处可作为两个支点，导致两处独立的骨折脱位。在涉及安全带约束的道路交通事故病例中，必须根据临床发现对脊柱进行全面的影像学评估。
