*Department of Neurosurgery, Taipei City Hospital, Zhong Xiao Branch, Taipei, Taiwan †Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ‡Department of Neurosurgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan §Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan ¶Department of Emergency, Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan ‖Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan **Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan ††Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan; and ‡‡Department of Neurosurgery, Lo-Hsu Foundation, Lotung Poh-Ai Hospital, Luodong, Yilan, Taiwan.
Spine (Phila Pa 1976). 2013 Dec 1;38(25):E1624-7. doi: 10.1097/01.brs.0000435023.57940.43.
Case report.
To describe the surgical technique and outcome of 2 cases of lap-shoulder belt injury involving burst fracture at L5 and cauda equina syndrome (CES).
Lap-shoulder belts have largely replaced lap belts in the front seats of cars, and therefore the concept of seat belt injury needs re-evaluation.
Two adults, the driver and front seat passenger in the same car involved in a collision, sustained lap-shoulder belt injury. One developed L5 Denis type A burst fracture and the other developed L5 Denis type B burst fracture. Both had CES. They were surgically managed by decompression of the spinal canal, which included removal of retropulsed fragments without impacting them. Both patients received short-segment transpedicle screws and rod system instrumentation without the fractured vertebra being included.
The percentage of preoperative degree of canal displacement of the retropulsed fragment was 60% in one patient and 55% in the other based on computed tomography. The mechanism of injury in both patients might be axial loading. After surgical intervention, the CES including lower leg weakness/numbness and bladder/bowel dysfunction clinically improved in both patients.
Two adults in the same car involved in a collision were wearing lap-shoulder belts, and 1 had Denis type A burst fracture at L5 and the other had Denis type B burst fracture at L5. Both developed CES after the accident. Both patients had a good clinical outcome after surgical treatment.
病例报告。
描述 2 例 lap-shoulder 安全带损伤合并 L5 爆裂骨折和马尾综合征（CES）的手术技术和结果。
lap-shoulder 安全带在汽车前排座位上已基本取代 lap 安全带，因此需要重新评估安全带损伤的概念。
2 名成年人，在同一辆车的碰撞中，驾驶员和前排乘客均受到 lap-shoulder 安全带损伤。一名患者出现 L5 Denis 型 A 爆裂骨折，另一名患者出现 L5 Denis 型 B 爆裂骨折。两者均出现 CES。通过椎管减压手术进行治疗，包括去除无影响的逆行移位碎片。两名患者均接受了短节段经皮椎弓根螺钉和棒系统固定术，不包括骨折椎体。
根据 CT 扫描，1 名患者的术前椎管内移位碎片的百分比为 60%，另 1 名患者为 55%。两名患者的损伤机制可能为轴向载荷。手术后，CES 包括小腿无力/麻木和膀胱/肠道功能障碍，两名患者的临床症状均有改善。
同一辆车的两名成年人均系着 lap-shoulder 安全带，1 名患者出现 L5 Denis 型 A 爆裂骨折，另 1 名患者出现 L5 Denis 型 B 爆裂骨折。事故后两者均出现 CES。两名患者均接受手术治疗，取得了良好的临床效果。
