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哈茨希尔矩形联合椎板下钢丝固定术在D4-D5骨折脱位伴急性脊髓损伤脊柱稳定中的应用——一种经济有效的治疗方法

Use of Hartshill Rectangle with Sublaminar Wiring in Spinal Stabilization of D4-D5 Fracture Dislocation with Acute Spinal Cord Injury - A Cost-Effective Treatment.

作者信息

Avhad Tanmay Anil, Gunay Siddharth, Kokate Sagar, Subith S

机构信息

Department of Orthopaedics, B.Y.L Nair Charitable Hospital, Mumbai, Maharashtra, India.

Department of Orthopaedics, HBT Medical College and Dr. R.N Cooper Hospital, Mumbai, Maharashtra, India.

出版信息

J Orthop Case Rep. 2024 Aug;14(8):179-184. doi: 10.13107/jocr.2024.v14.i08.4692.

DOI:10.13107/jocr.2024.v14.i08.4692
PMID:39157490
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11327672/
Abstract

INTRODUCTION

Fractures in the upper thoracic spine pose technical challenges due to the transition from cervical to thoracic spine, often resulting in complete spinal cord injuries necessitating stabilization. Various posterior fixation techniques include Harrington rods, wired distraction rods, L-rods with sub-laminar wiring, and pedicle screw fixation. Luque pioneered sublaminar wiring (SLW), later enhanced by Dove's Hartshill system for superior biomechanical stability. This case underscores the efficacy of the Hartshill system in stabilizing upper thoracic fractures with severe cord injuries, offering a cost-effective alternative to pedicle screw fixation.

CASE REPORT

A 30-year-old female with polytrauma presented symptoms of lower limb paralysis, bladder and bowel dysfunction, and loss of sensation. Imaging showed a severe D4-D5 fracture with retrolisthesis and spinal cord compression, necessitating surgical stabilization using a Hartshill rectangle with SLW. Following surgery, early rehabilitation and physical therapy were initiated, demonstrating the effectiveness of proper fixation in facilitating early mobilization.

CONCLUSION

The Hartshill rectangle, with SLW, offers enduring spinal stabilization for unstable thoracic fractures with spinal cord injuries, enabling early mobilization and reducing neurological risks. Its versatile application spans scoliosis corrections and trauma-related spinal stabilization, reflecting its widespread use in spinal surgery.

摘要

引言

由于从颈椎到胸椎的过渡，上胸椎骨折带来了技术挑战，常常导致完全性脊髓损伤，因此需要进行稳定治疗。各种后路固定技术包括哈灵顿棒、钢丝撑开棒、带椎板下钢丝的L形棒和椎弓根螺钉固定。卢克开创了椎板下钢丝技术（SLW），后来多夫的哈茨希尔系统对其进行了改进，以获得更好的生物力学稳定性。本病例强调了哈茨希尔系统在稳定伴有严重脊髓损伤的上胸椎骨折方面的有效性，为椎弓根螺钉固定提供了一种经济有效的替代方案。

病例报告

一名30岁的多发伤女性出现下肢瘫痪、膀胱和肠道功能障碍以及感觉丧失的症状。影像学检查显示严重的D4 - D5骨折伴椎体后移和脊髓受压，需要使用带SLW的哈茨希尔矩形装置进行手术稳定治疗。手术后，立即开始早期康复和物理治疗，显示出适当固定在促进早期活动方面的有效性。

结论

带SLW的哈茨希尔矩形装置为伴有脊髓损伤的不稳定胸椎骨折提供了持久的脊柱稳定，能够实现早期活动并降低神经风险。其广泛应用涵盖脊柱侧弯矫正和创伤相关的脊柱稳定，反映了其在脊柱手术中的广泛使用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a89/11327672/a51a1b6087e0/JOCR-14-179-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a89/11327672/4cf29e1d2dfc/JOCR-14-179-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a89/11327672/430616c04dcd/JOCR-14-179-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a89/11327672/275ad31233a9/JOCR-14-179-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a89/11327672/5b547db4c85e/JOCR-14-179-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a89/11327672/a51a1b6087e0/JOCR-14-179-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a89/11327672/4cf29e1d2dfc/JOCR-14-179-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a89/11327672/430616c04dcd/JOCR-14-179-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a89/11327672/275ad31233a9/JOCR-14-179-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a89/11327672/5b547db4c85e/JOCR-14-179-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a89/11327672/a51a1b6087e0/JOCR-14-179-g006.jpg

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