Chu Daniel Y, Greeneway Garret P, Falls Cody J, Page Paul S, Ahmed Azam S
Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States.
Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States.
Surg Neurol Int. 2022 Dec 23;13:593. doi: 10.25259/SNI_1046_2022. eCollection 2022.
A Chance fracture is a traumatic fracture of the thoracic or lumbar spine that occurs secondary to a flexion-distraction injury. Although patients with chance fractures rarely present with neurologic deficits, a subset may become symptomatic from spinal epidural hematomas (SEH) warranting emergent decompressive surgery.
An 87-year-old female on anticoagulation presented with a T1 Chance fracture after a fall. She was originally neurologically intact, but became paraplegic over the next 10 h. When the cervical/thoracic magnetic resonance revealed a SEH markedly compressing the cord between the C7-T1 levels, she underwent an emergent decompression; she also had a C5-T4 instrumented fusion. Postoperatively, she regained lower limb function, but expired on postoperative day 5 due to respiratory complications likely attributed to the prolonged surgery for the spinal instrumentation.
Delayed SEH rarely occur following spinal Chance fractures. Here, an 87-year-old female on anticoagulation developed the 10-h delayed onset of a SEH with paraplegia attributed to a T1 Chance fracture at the C7-T1 level. Although she regained neurological function following the emergent decompression, she expired 5 days later likely due to the extended operative time/blood loss from the C5-T4 fusion that could have been avoided.
Chance骨折是继发于屈曲-牵张损伤的胸腰椎创伤性骨折。尽管Chance骨折患者很少出现神经功能缺损，但一部分患者可能因脊髓硬膜外血肿（SEH）出现症状，需要紧急减压手术。
一名87岁正在接受抗凝治疗的女性在跌倒后出现T1椎体Chance骨折。她最初神经功能完好，但在接下来的10小时内出现截瘫。当颈椎/胸椎磁共振成像显示一个SEH明显压迫C7-T1水平的脊髓时，她接受了紧急减压手术；她还进行了C5-T4节段的内固定融合术。术后，她恢复了下肢功能，但在术后第5天因呼吸并发症死亡，这可能归因于脊柱内固定手术时间过长。
脊髓Chance骨折后很少发生延迟性SEH。在此，一名87岁正在接受抗凝治疗的女性因T1椎体Chance骨折在C7-T1水平出现了10小时延迟发作的SEH并导致截瘫。尽管她在紧急减压术后恢复了神经功能，但5天后死亡，可能是由于C5-T4融合术延长的手术时间/失血，而这原本是可以避免的。
