Pesenti Sebastien, Blondel Benjamin, Faure Alice, Peltier Emilie, Launay Franck, Jouve Jean-Luc
Sebastien Pesenti, Emilie Peltier, Franck Launay, Jean-Luc Jouve, Pediatric Orthopaedics, Hopital d'Enfants de la Timone, Aix Marseille University, 13005 Marseille, France.
World J Clin Cases. 2016 Sep 16;4(9):264-8. doi: 10.12998/wjcc.v4.i9.264.
Paediatric Chance fracture are rare lesions but often associated with abdominal injuries. We herein present the case of a seven years old patient who sustained an entrapment of small bowel and an ureteropelvic disruption associated with a Chance fracture and spine dislocation following a traffic accident. Initial X-rays and computed tomographic (CT) scan showed a Chance fracture with dislocation of L3 vertebra, with an incarceration of a small bowel loop in the spinal canal and a complete section of the left lumbar ureter. Paraplegia was noticed on the initial neurological examination. A posterior L2-L4 osteosynthesis was performed firstly. In a second time she underwent a sus umbilical laparotomy to release the incarcerated jejunum loop in the spinal canal. An end-to-end anastomosis was performed on a JJ probe to suture the left injured ureter. One month after the traumatism, she started to complain of severe headaches related to a leakage of cerebrospinalis fluid. Three months after the traumatism there was a clear regression of the leakage. One year after the trauma, an anterior intervertebral fusion was done. At final follow-up, no neurologic recovery was noticed. In case of Chance fracture, all physicians should think about abdominal injuries even if the patient is asymptomatic. Initial abdominal CT scan and magnetic resonance imaging provide in such case crucial info for management of the spine and the associated lesions.
儿童Chance骨折是罕见的损伤，但常与腹部损伤相关。我们在此报告一例7岁患者，在交通事故后发生小肠嵌顿、输尿管肾盂断裂，并伴有Chance骨折和脊柱脱位。最初的X线和计算机断层扫描（CT）显示L3椎体Chance骨折伴脱位，椎管内有一小肠袢嵌顿，左腰段输尿管完全离断。初次神经学检查发现截瘫。首先进行了L2-L4后路骨固定术。第二次手术时，她接受了脐上剖腹手术，以松解椎管内嵌顿的空肠袢。通过置入双J管进行端端吻合来缝合左侧受损输尿管。受伤1个月后，她开始抱怨因脑脊液漏导致的严重头痛。受伤3个月后，脑脊液漏明显减轻。受伤1年后，进行了前路椎间融合术。在最后一次随访时，未发现神经功能恢复。对于Chance骨折，即使患者无症状，所有医生也应考虑腹部损伤。在这种情况下，最初的腹部CT扫描和磁共振成像可为脊柱及相关损伤的处理提供关键信息。
