Bourghli Anouar, Obeid Ibrahim, Boissiere Louis, Vital Jean-Marc, Tabboush Zafer, Al Sarawan Mohammed
Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O.Box 84400, Riyadh, 11671, Saudi Arabia.
Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France.
Eur Spine J. 2018 Jul;27(7):1547-1552. doi: 10.1007/s00586-017-5247-8. Epub 2017 Aug 9.
Chance fracture of the high thoracic spine is rare, and its impact on the adjacent cervical spine can be important.
We present the case of a 16-year-old male, who fell down from a 2 m height, in an unknown context as he has a mental retardation, and no witness saw the accident. Initial CT scan revealed a comminuted depressed fracture of the right parietal bone, associated with a chance fracture at the level of T3 with a kyphosis and bilateral lung contusion.
The patient underwent neurosurgical treatment for elevation and reconstruction of the parietal fracture; he also underwent, 2 days later, a posterior spinal correction and fusion with T1-to-T5 instrumentation. The patient returned to normal walking on day 7 with a satisfactory clinical and radiological result at 1 year.
Literature is sparse on the treatment of high thoracic chance fractures. The current case shows that early surgical management should prevent a secondary kyphotic deformity that may need a more aggressive treatment at a later stage.
高位胸椎 Chance 骨折较为罕见，其对相邻颈椎的影响可能较为重要。
我们报告一例 16 岁男性病例，该患者因智力发育迟缓在不明情况下从 2 米高处坠落，且无目击者看到事故经过。初始 CT 扫描显示右侧顶骨粉碎性凹陷骨折，伴有 T3 水平的 Chance 骨折、后凸畸形及双侧肺挫伤。
患者接受了颅骨骨折抬高及重建的神经外科治疗；两天后，又接受了后路脊柱矫正及 T1 至 T5 内固定融合术。患者在第 7 天恢复正常行走，1 年后临床及影像学结果满意。
关于高位胸椎 Chance 骨折治疗的文献较少。当前病例表明，早期手术治疗可预防后期可能需要更积极治疗的继发性后凸畸形。
