双侧孤立性 C5 肩部瘫痪：颈椎 C4-C5 间盘后突骨折的非典型表现。
Bilateral isolated C5 paralysis of the shoulder: Atypical presentation of a transdiscal C4-C5 cervical spine fracture.
机构信息
Orthopaedics and Trauma Surgery, EHC Morges, Morges, Switzerland
Orthopaedics and Trauma Surgery, EHC Morges, Morges, Switzerland.
出版信息
BMJ Case Rep. 2021 Mar 1;14(3):e236323. doi: 10.1136/bcr-2020-236323.
After a low-energy fall, an 83-year-old man presented with bilateral weakness of the upper arms without loss of sensation associated with a rigid cervical spine (ankylosing spinal disorder, ASD). Because of an atypical presentation during history, examination and initial imaging, a late diagnosis of a transdiscal C4-C5 fracture was made by dynamic radiographs. Anterior cervical discectomy and fusion were performed with delay. Strength improved from grade C to D (American Spinal Injury Association classification) after surgery. To our knowledge, this is the first description of a bilateral, isolated upper limb C5 paralysis without any loss of sensation caused by a transdiscal C4-C5 fracture. A high clinical and diagnostic index of suspicion is mandatory to make the diagnosis. We present three clinical 'Awareness Criteria' (1: recognition of ASD; 2: high index of fracture suspicion; 3: necessary imaging) helping clinicians to safely and promptly diagnose occult spinal fractures in ASD.
一位 83 岁男性因低能量跌倒就诊，表现为双侧上臂无力，无感觉丧失，伴有刚性颈椎（强直性脊柱炎，ASD）。由于病史、检查和初始影像学表现不典型，通过动态 X 线片诊断为迟发性 C4-C5 椎间盘内骨折。行前路颈椎间盘切除融合术，但有延误。术后上肢力量从 C 级改善至 D 级（美国脊髓损伤协会分级）。据我们所知，这是首例描述由 C4-C5 椎间盘内骨折引起的无任何感觉丧失的双侧孤立性 C5 上肢瘫痪。为了做出明确诊断，需要高度的临床和诊断怀疑指数。我们提出了三个临床“意识标准”（1：识别 ASD；2：高骨折怀疑指数；3：必要的影像学），帮助临床医生安全、迅速地诊断 ASD 中的隐匿性脊柱骨折。
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