Abdel-Fattah H, Rizk A H
Orthopedic Department, Faculty of Medicine, Cairo University, Egypt.
Clin Orthop Relat Res. 1990 Feb(251):140-3.
Complete posterior fracture-dislocation of the lumbar spine at L4-L5 level occurred in an 18-year-old male patient, who remained neurologically intact. The body of L4 with the vertebral column above was totally displaced behind the body of L5. The posterior elements of L5 were fractured and displaced posteriorly with L4, and this led to marked widening of the canal with spontaneous neurologic decompression. Open reduction and internal fixation with a sacral rod and two Harrington rods restored the anatomic relationship. In spite of the good reduction immediately obtained after surgery, two months later the fracture showed some redisplacement. The implants were removed, and a bone graft was transplanted for additional support. Seven months after trauma, the patient is asymptomatic and the spine is solidly fused. In spite of the risk of neurologic deterioration involved during surgery, open reduction and internal fixation were performed because they offered the best chance of healing, producing a biomechanically sound spine, and decreasing the risk of delayed neurologic deterioration. Because of the relatively wide neural canal at the lumbar level and the absence of spinal cord from the neural elements at the level of the injury, the risk of permanent neurologic deficit being produced during surgery was considered minimal.
一名18岁男性患者发生L4 - L5水平的腰椎完全后脱位骨折，其神经功能保持完好。L4椎体及其上方的脊柱完全移位至L5椎体后方。L5的后部结构骨折并与L4一起向后移位，导致椎管明显增宽并伴有自发性神经减压。采用骶骨棒和两根哈灵顿棒进行切开复位内固定，恢复了解剖关系。尽管术后立即获得了良好的复位，但两个月后骨折出现了一些再移位。取出植入物，并进行了植骨以提供额外支撑。创伤后七个月，患者无症状，脊柱已牢固融合。尽管手术存在神经功能恶化的风险，但仍进行了切开复位内固定，因为这提供了最佳的愈合机会，能形成生物力学稳定的脊柱，并降低延迟性神经功能恶化的风险。由于腰椎水平的神经管相对较宽，且损伤水平的神经结构中没有脊髓，因此手术中产生永久性神经功能缺损的风险被认为极小。
