Coscia M F
Orthopaedics Indianapolis Inc., Indiana, USA.
Spine (Phila Pa 1976). 1997 Nov 15;22(22):2698-701. doi: 10.1097/00007632-199711150-00020.
A previously undescribed clinic entity is presented, along with suggestions to prevent its reoccurrence.
To identify a potential pitfall in the use of pedicle screw instrumentation in trauma cases. Also, to emphasize the need to identify and treat noncontiguous spinal fractures.
No previous cases have yet been described with this particular complication, which would be remedied easily with established methods. Pedicle screw instrumentation previously has been associated primarily with complications due to aberrant screw insertion and injury to adjoining tissues, or due to fracture of the construct itself in the absence of fusion formation.
A 15-year-old girl suffered a traumatic T12-L1 fracture dislocation and paraplegia. After pedicle screw instrumentation, her apparently benign L3 fracture progressed to a severely displaced Chance fracture. This was repaired with caudal laminar hook compression instrumentation.
Postoperatively, at a 1-year follow-up, the patient's spinal deformity was completely alleviated, though she remains paraplegic.
Unstable traumatic spinal injuries treated with pedicular instrumentation should have additional laminar hook compression configuration reinforcement at the ends of the constructs to prevent further stress-induced injury from the screws alone. Instrumentation constructs should not end at even minimally fractured levels.
介绍了一种先前未描述的临床实体，并提出了预防其复发的建议。
识别创伤病例中使用椎弓根螺钉器械的潜在陷阱。此外，强调识别和治疗非相邻脊柱骨折的必要性。
此前尚未有过这种特殊并发症的病例描述，采用既定方法可轻松纠正。椎弓根螺钉器械先前主要与螺钉插入异常及对相邻组织的损伤导致的并发症相关，或者与在未形成融合的情况下结构本身的骨折相关。
一名15岁女孩遭受T12-L1创伤性骨折脱位并截瘫。在进行椎弓根螺钉器械固定后，她看似良性的L3骨折发展为严重移位的Chance骨折。采用尾侧椎板钩加压器械进行修复。
术后1年随访时，患者的脊柱畸形完全缓解，尽管她仍截瘫。
采用椎弓根器械治疗的不稳定创伤性脊柱损伤，应在结构末端增加椎板钩加压结构加固，以防止仅由螺钉引起的进一步应力性损伤。器械结构不应在即使是最小程度骨折的水平处结束。
