Wang Chien Chieh, Wu Tsung-Mu, Chien Chi-Sheng, Huang Chi-Ming, Wong Kin Weng
Department of Orthopedics Chi-Mei Medical Center Tainan Taiwan.
Department of Leisure and Sports Management CTBC University of Technology Tainan Taiwan.
Clin Case Rep. 2024 Oct 24;12(11):e9510. doi: 10.1002/ccr3.9510. eCollection 2024 Nov.
Lumbar facet fracture-dislocation is rare, often due to hyperflexion with rotational force. Abnormal scoliosis on radiography is a key sign, prompting further imaging. Facetectomy and laminectomy ensure safe reduction, while instrumented fusion is an effective surgical treatment.
Traumatic lumbar facet dislocation is an uncommon condition, particularly when unilateral lumbar facet dislocation is accompanied by a contralateral facet fracture. The patient had a locked facet joint at the left L4-L5, a fracture of the right superior articular process of L5 and a comminuted fracture at the peritrochanteric region of the right femur following a fall. Emergent operation was conducted, starting with open reduction and fixation for the right proximal femur, followed by posterior open reduction and posterolateral fusion with instrumentation, without interbody fusion, for the lumbar spine injury. The patient exhibited positive outcomes throughout the follow-up. This article highlights the trauma mechanism of lumbar facet dislocation, emphasizing hyperflexion with rotational force. Abnormal local scoliosis is a distinctive imaging sign of facet joint dislocation. Facetectomy and laminectomy are recommended for safe reduction and instrumented fusion is considered a safe and effective surgical treatment for facet joint dislocation injuries.
腰椎小关节骨折脱位罕见，通常由伴有旋转力的过度屈曲所致。X线片上的异常脊柱侧凸是关键征象，提示需进一步影像学检查。小关节切除术和椎板切除术可确保安全复位，而器械融合术是一种有效的手术治疗方法。
创伤性腰椎小关节脱位是一种少见情况，尤其是单侧腰椎小关节脱位伴有对侧小关节骨折时。该患者跌倒后出现左侧L4-L5小关节交锁、L5右侧上关节突骨折以及右侧股骨转子周围粉碎性骨折。进行了急诊手术，首先对右股骨近端进行切开复位内固定，随后对腰椎损伤行后路切开复位及后路外侧器械融合术，未行椎间融合。患者在整个随访过程中预后良好。本文强调了腰椎小关节脱位的创伤机制，重点是伴有旋转力的过度屈曲。局部异常脊柱侧凸是小关节脱位的独特影像学征象。推荐行小关节切除术和椎板切除术以确保安全复位，器械融合术被认为是治疗小关节脱位损伤的一种安全有效的手术方法。
