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无神经功能异常的颈椎骨折脱位:罕见病例报告。

Cervical fracture dislocation without neurological abnormality: Rare case reports.

作者信息

Japamadisaw Aliefio, Hidayat Aries Rakhmat

机构信息

Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

出版信息

Int J Surg Case Rep. 2024 Jul;120:109814. doi: 10.1016/j.ijscr.2024.109814. Epub 2024 May 29.

Abstract

INTRODUCTION AND IMPORTANCE

Traumatic lower cervical dislocation with spinal cord injury (SCI) can cause long-lasting dysfunction in many organ systems resulting in significant financial burden and functional disability. The patient may come with complete or incomplete neurological deficit. However, there is also possibility of no neurological deficit.

CASE PRESENTATION

This case reports presented two cases of a 68-year-old man and a 54-year-old man that came to the emergency department after a traffic accident and fell from a height. Surprisingly there was no neurological deficit found on both patients. The patient underwent emergency open reduction and posterior stabilization. Several months later, the neurological function was still excellent, and the pain was absent.

CLINICAL DISCUSSION

Traumatic cervical dislocation without neurological deficit is rare. Enlargement of the spinal canal is significant when the vertebral body and the shattered posterior arch separate, which may play a protective role on the spinal cord. The neurological deficit did not happen in the first case due to a widening spinal canal. Still, in the second case, the patient's neurological condition remained excellent despite no disruption on the posterior arch after cervical dislocation.

CONCLUSION

Neurological deficit may not occur in the cervical dislocation with disruption of the posterior arch due to the widening of the spinal canal. This injury should be treated properly to prevent other morbidities and even mortality. The posterior technique for stabilization gives various benefits, such as the safety and familiarity of the procedure and the high success rate.

摘要

引言与重要性

创伤性下颈椎脱位伴脊髓损伤(SCI)可导致多个器官系统出现长期功能障碍,造成巨大经济负担和功能残疾。患者可能伴有完全或不完全神经功能缺损。然而,也有可能不存在神经功能缺损。

病例介绍

本病例报告呈现了两例患者,一名68岁男性和一名54岁男性,他们在交通事故和高处坠落后来到急诊科。令人惊讶的是,两名患者均未发现神经功能缺损。患者接受了急诊切开复位和后路固定术。数月后,神经功能仍然良好,且无疼痛。

临床讨论

创伤性颈椎脱位而无神经功能缺损较为罕见。当椎体与破碎的后弓分离时,椎管会显著扩大,这可能对脊髓起到保护作用。第一例患者未出现神经功能缺损是由于椎管增宽。然而,在第二例患者中,尽管颈椎脱位后后弓未受损,但其神经状况仍保持良好。

结论

由于椎管增宽,颈椎脱位伴后弓断裂时可能不会出现神经功能缺损。应妥善治疗此类损伤以预防其他并发症甚至死亡。后路固定技术具有多种益处,如手术的安全性和术者的熟悉程度以及高成功率。

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