MacLennan Matthew H, El-Mughayyar Dana, Attabib Najmedden
Department of Medicine, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada.
Canada East Spine Centre, Saint John, New Brunswick, Canada; and.
J Neurosurg Case Lessons. 2021 Dec 6;2(23):CASE21564. doi: 10.3171/CASE21564.
Chance fractures are unstable due to horizontal extension of the injury, disrupting all three columns of the vertebra. Since being first described in 1948, Chance fractures have been commonly found at a single level near the thoracolumbar junction. Noncontiguous double-level Chance fractures that result from a single traumatic event are rarely reported in the literature.
The authors report a case of an 18-year-old male who presented to the emergency department after a rollover motor vehicle accident. The patient complained of severe back pain when at rest and had no neurological deficits. Computed tomography revealed two unstable Chance fractures of bony subtype located at T6 and T11. The patient underwent percutaneous stabilization from T4 to T12. The postoperative assessment revealed continued 5/5 power bilaterally in all extremities, back pain, and the ability to ambulate with a walker. At 3 months after the operation, clinical assessment revealed no significant back pain and the ability to walk independently. Imaging confirmed stable fixation of the spine with no acute osseous or hardware complications.
This report complements previous studies demonstrating support for more extensive stabilization for such unique fractures. Additionally, rapid radiological imaging is needed to identify the full injury and lead patients to appropriate treatment.
由于损伤的水平延伸，Chance骨折不稳定，会破坏椎体的所有三柱。自1948年首次被描述以来，Chance骨折常见于胸腰段交界处附近的单一节段。文献中很少报道由单一创伤事件导致的非连续性双节段Chance骨折。
作者报告了一例18岁男性患者，该患者在机动车翻车事故后被送往急诊科。患者休息时诉严重背痛，无神经功能缺损。计算机断层扫描显示T6和T11处有两处不稳定的骨型Chance骨折。患者接受了从T4到T12的经皮固定。术后评估显示四肢双侧肌力持续为5/5，有背痛，可借助助行器行走。术后3个月，临床评估显示无明显背痛，能够独立行走。影像学检查证实脊柱固定稳定，无急性骨质或器械并发症。
本报告补充了先前的研究，表明支持对这类独特骨折进行更广泛的固定。此外，需要快速进行放射学成像以确定完整损伤情况，并引导患者接受适当治疗。
