Department of Surgery, University of Munich, Germany.
Spine (Phila Pa 1976). 2010 May 20;35(12):E553-8. doi: 10.1097/BRS.0b013e3181cf6b93.
A case report.
To report the successful surgical management of a patient with a displaced sternal fracture associated with flexion-compression injury to the thoracic spine by flexible intramedullary nailing of the sternum, thereby emphasizing the existence and clinical relevance of the concept of the fourth column of the thoracic spine.
Displaced sternal fractures resulting from indirect trauma are often associated with unstable injuries to the thoracic spine that require stabilization of the spine to prevent increasing kyphosis. The theory of the sternal-rib-complex as a possible fourth column giving structural support to the thoracic spine has been proposed. However, such a model has rarely been described, and the role of surgical stabilization of an unstable fourth column is unknown.
A 58-year-old man with Forestier syndrome presented with a severely displaced sternal fracture associated with an unstable injury to the thoracic spine at T4-T8 after a fall at ground level. The patient complained of sternal pain and respiratory distress. However, neurologically he was completely normal. His pain and respiratory distress improved, so he refused spinal stabilization, and was discharged 20 days after the injury.
Eight weeks after the injury the patient complained of persistent sternal pain and symptoms of sternal instability. A computed tomogram (CT) showed increasing displacement of the sternal fracture and increasing kyphosis of the thoracic spine. To relieve the sternal pain and prevent further displacement the patient now agreed to stabilization of the sternal fracture by minimal invasive flexible intramedullary nailing. Postoperative CT showed an almost anatomically-reduced sternum and even a slight correction of the thoracic kyphosis. After removal of the implants 5 months later the patient was free of pain, and was able to resume normal physical activity and return to his work as a farmer. Thirty months after sternal stabilization surgery, CT showed complete healing of the sternal fracture and a continuing reduction of the thoracic kyphosis.
This case supports the concept of the existence and clinical relevance of the fourth column of the thoracic spine, and its role in giving added spinal stability.
病例报告。
报告 1 例胸骨移位骨折伴胸脊柱屈伸性压缩损伤患者采用胸骨弹性髓内钉成功治疗的病例，强调胸脊柱第四柱的存在和临床相关性。
间接创伤引起的胸骨移位骨折常伴有不稳定的胸脊柱损伤，需要稳定脊柱以防止后凸增加。提出了胸骨肋骨复合体作为可能的第四柱为胸脊柱提供结构支撑的理论。然而，这种模型很少被描述，不稳定第四柱的手术稳定性作用尚不清楚。
1 例 58 岁男性，因平地跌倒致 Forestier 综合征，出现严重胸骨移位骨折伴 T4-T8 胸脊柱不稳定损伤，患者诉胸骨疼痛和呼吸困难。但神经学检查完全正常。疼痛和呼吸困难缓解后，患者拒绝脊柱稳定治疗，伤后 20 天出院。
受伤后 8 周，患者诉持续胸骨疼痛和胸骨不稳定症状。CT 显示胸骨骨折移位增加和胸脊柱后凸增加。为缓解胸骨疼痛和防止进一步移位，患者现在同意采用微创弹性髓内钉固定胸骨骨折。术后 CT 显示胸骨几乎解剖复位，甚至轻度矫正胸脊柱后凸。5 个月后取出植入物后，患者疼痛消失，能够恢复正常体力活动并重返农民工作。胸骨稳定手术后 30 个月，CT 显示胸骨骨折完全愈合，胸脊柱后凸持续减少。
该病例支持胸脊柱第四柱的存在和临床相关性及其在增加脊柱稳定性方面的作用的概念。
