经椎间孔腰椎椎间融合术后骨移植物早期移位致乙状结肠穿孔
Early migration of bone graft causing sigmoid colon perforation after trans-foraminal lumbar interbody fusion.
作者信息
Garg Bhavuk, Singla Amit, Batra Sahil, Kumar Senthil
机构信息
Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
出版信息
J Clin Orthop Trauma. 2017 Apr-Jun;8(2):165-167. doi: 10.1016/j.jcot.2016.12.008. Epub 2017 Jan 2.
BACKGROUND
Tran foraminal lumbar interbody fusion (TLIF) is a well accepted and standard technique of achieving spinal fusion using pedicle screws, cage and bone graft. We are presenting here a case of L4-L5 lumbar canal stenosis managed with TLIF that presented with sigmoid colon perforation due to bone graft migration 4 days after surgery.
CASE REPORT
A 35 years old female underwent open TLIF (from right side) with decompression for L4-L5 lumbar canal stenosis. On 4th post op day she started having abdominal pain and distension. After radiograph reveled gas under diaphragm emergency laparotomy was done and 1 by 1 cm sigmoid colon perforation seen near recto-sigmoid junction. Bony spicules with sharp edges were seen embedded inside the perforation.
DISCUSSION
The purpose of this case report is to present a rare complication and to raise awareness and high index of suspicion among spine surgeons for prevention, early detection and treatment.
背景
经椎间孔腰椎椎体间融合术（TLIF）是一种广泛接受的标准技术，通过椎弓根螺钉、椎间融合器和骨移植来实现脊柱融合。我们在此报告一例因L4-L5腰椎管狭窄行TLIF术后4天出现骨移植移位导致乙状结肠穿孔的病例。
病例报告
一名35岁女性因L4-L5腰椎管狭窄接受了右侧开放式TLIF减压手术。术后第4天，她开始出现腹痛和腹胀。经X线检查发现膈下游离气体后，进行了急诊剖腹探查术，在直肠乙状结肠交界处附近发现了一个1×1厘米的乙状结肠穿孔。穿孔内可见边缘锐利的骨碎片。
讨论
本病例报告的目的是呈现一种罕见的并发症，并提高脊柱外科医生对其预防、早期发现和治疗的认识及高度怀疑指数。
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