Bhattarai Ashbin, Gurung Bijaya, Sherchan Binod, Rijal Badri, Karki Prasanna D
National Academy of Medical Sciences, Kathmandu, Nepal.
Ann Med Surg (Lond). 2024 Nov 5;86(12):7431-7435. doi: 10.1097/MS9.0000000000002707. eCollection 2024 Dec.
K wire is one of the most common implants used for fixation of acromioclavicular joint dislocation. The migration of K wire from the AC joint to the spinal canal is a rare occurrence. In this report, the authors present a case of a young adult who presented with weakness of the left upper limb secondary to migration of the K wire from the AC joint to the spinal canal.
A 46-year-old male farmer presented with complaints of pain in the neck, tingling sensation in the left upper limb, and a tender palpable swelling on the left side of his neck with weakness of finger flexors and abductors. He had had an open reduction and fixation with K wire for Acromioclavicular dislocation three months back. CT confirmed the K wire is passing through the neural foramen between C5 and C6 vertebra and extending across the entire diameter of the spinal canal. Under intravenous anesthesia, a transverse skin incision was made over the prominent swelling on the neck, and the wire was gently removed. Minimal seepage of spinal fluid was observed, which stopped on its own after a few days.
Although AC joint stabilization by K wire fixation provides a safe and easy fixation with low morbidity, complications such as a loss of fixation or loosening can occur. Migration of K wire into a spinal canal is a well-known but infrequent complication. Resorption of bone, muscle action, and negative intrathoracic pressures associated with respiration and heat necrosis causes progressive loosening and dislodgement. Spinal migration is very dangerous because it can cause serious damage to the dura mater, spinal cord, and vertebral artery.
Early identification and removal of the K wire, once it has migrated from the site of use, is mandatory to prevent its grievous complications.
克氏针是用于固定肩锁关节脱位最常用的植入物之一。克氏针从肩锁关节迁移至椎管是一种罕见的情况。在本报告中，作者介绍了一例年轻成年人因克氏针从肩锁关节迁移至椎管继发左上肢无力的病例。
一名46岁男性农民，主诉颈部疼痛、左上肢有刺痛感，左侧颈部可触及压痛性肿胀，伴有手指屈肌和外展肌无力。他三个月前因肩锁关节脱位接受了克氏针切开复位固定术。CT证实克氏针穿过C5和C6椎体之间的神经孔并延伸至椎管的整个直径。在静脉麻醉下，于颈部突出肿胀处做一横形皮肤切口，将克氏针轻轻取出。观察到有少量脑脊液渗漏，几天后自行停止。
尽管克氏针固定肩锁关节可提供安全简便的固定且发病率低，但可能会出现固定失效或松动等并发症。克氏针迁移至椎管是一种已知但不常见的并发症。与呼吸相关的骨吸收、肌肉活动及胸腔内负压以及热坏死会导致克氏针逐渐松动和移位。椎管内迁移非常危险，因为它可能会对硬脑膜、脊髓和椎动脉造成严重损伤。
一旦克氏针从使用部位迁移，必须尽早识别并取出，以防止其严重并发症的发生。
