背景:由于后凸排列,胸椎是稳定的,胸腔,和肋骨关节。胸椎的任何压迫或脊柱后凸都会导致脊髓损伤。
方法:一名47岁男性,入院前1天出现背痛,在他被摩托车碾碎并背上着陆后。疼痛,辐射到四肢,伴随着严重的痉挛,麻木,和他下肢的虚弱,但没有尿失禁。没有其他相关伤害的报告。25年前,他有脊柱结核病史,背部进行性畸形,他没有手术就接受了药物治疗。检查:T11-L1的吉布斯,炎症后皮肤色素沉着过多,脊柱容易触及,力量1/5右下肢和2/5左下肢,感觉和肺球反射完整。上肢神经完整。所有实验室调查,包括FBP,ESR,电解质,肾功能和肝功能检查均在正常范围内.放射成像后,脊髓损伤的最终诊断,ASIAC.AO分类类型T12-L1:C/T9-L1:A4/N3/M2。在开始脊柱方案后6周,他被保持在胸腰椎紧身胸衣上。他出院8周,这次患者没有背痛,但在神经方面没有改善。经过一年的胸腰椎紧身胸衣和理疗,他报告没有更多的背部疼痛,下肢没有麻木,并向右3/5和左4/5下肢提供动力,完整的感觉。然而,在放射学上没有观察到变化.
■由于骨折脱位的不稳定性,手术治疗建议重新调整脊柱,但对于这种情况,背部畸形和椎体骨折,最好不要减少和固定,因为它会进一步恶化患者的神经功能缺损,在演习中,同时做减少。
结论:胸椎骨折脱位可影响患者的身心健康。手术固定和器械是理想的,但在手术干预会进一步损害患者神经功能的情况下,保守治疗是目标。
BACKGROUND: The thoracic spine is stable because of kyphotic alignment, rib cage, and costovertebral joints. Any compression or kyphosis in the thoracic spine always causes spinal cord injury.
METHODS: A 47-year-old male with complaints of back pain 1 day prior to admission, after he sustained a motorbike crush and landed on his back. The pain, radiates to both limbs, associated with severe spasms, numbness, and weakness in his lower extremities, however no incontinence. No other associated injuries were reported. 25 years ago he had a history of tuberculosis of the spine with progressive deformity of the back, he was treated medically without surgery. On examinations: Gibbus at T11-L1, with hyper-pigmented post-inflammatory skin and an easily palpable spine, power 1/5 right and 2/5 left lower limbs, Sensation and bulbocarvenosus reflex were intact. Upper limbs were neurologically intact. All laboratory investigations including FBP, ESR, Electrolytes, renal and liver function tests were all within normal range. After radiological imaging, a final diagnosis of Spinal Cord Injury, ASIA C. AO classification type T12-L1:C/T9-L1:A4/N3/M2 was made. He was kept on a thoracolumbar corset 6 weeks after being initiated on spine protocol. He was discharged 8 weeks this time patient had no back pain but no improvement was noted neurologically. After a year of thoracolumbar corset and physiotherapy, he reported no more back pain, no numbness to lower limbs, and power 3/5 right and 4/5 left lower limbs, with intact sensation. However, no changes were observed radiologically.
UNASSIGNED: Due to the instability of fracture-dislocation, surgical treatment is recommended to realign the spine but for this case with back deformity and fractured vertebra bodies, it is best not to temper with reduction and fixation as it would further worsen the neurological deficit of the patient, during maneuvers while doing the reduction.
CONCLUSIONS: Fracture-dislocation of the thoracic spine can impact the physical and mental well-being of the patients. Surgical fixation and instrumentation are ideal but in cases where surgical intervention would further impair the neurological function of the patient conservative management is the goal.