脊柱融合术治疗一名青少年 C6 椎体劈裂性骨折伴脊髓受压的疗效(病例史)

L. Ngankam, A. M. Fomin, A. B. Mikhalchuk, E. V. Guseva
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摘要

C5-Th1椎体骨折和脱位骨折约占所有脊柱损伤的70%。本文介绍了一例通过自体骨脊柱融合术成功治疗 C6 椎体骨折的病例。为诊断目的而进行的螺旋计算机断层扫描(SCT)和磁共振成像(MRI)显示,C6脊椎骨碎裂性骨折伴有脊髓压迫和轻度脊髓肿胀。临床表现为颈椎急性疼痛、四肢瘫痪以及因损伤的严重程度和水平而导致的盆腔器官功能紊乱。患者同时接受了两次手术:第一次手术从左侧髂骨翼取了一块自体骨碎片,第二次手术用自体骨进行了 C5-C7 脊柱融合,并用钛板进行了固定。手术后,随访的 C 型脊柱 SCT 显示没有脊髓受压的迹象,椎管的楔形变形也得到了纠正。椎体没有移位,椎骨和椎间盘的高度也没有变化。治疗后,患者将接受长期康复措施。所获得的结果证明了自体骨脊柱融合术与前路低位钛板四螺钉固定的疗效。由于为患者提供了正确和及时的医疗护理,所有治疗目标(最大限度地减少脊髓的二次损伤、确保血液供应紊乱区域的神经元和轴突恢复的最佳条件、脊柱稳定)均已实现。
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Efficacy of spinal fusion in treatment of splintered fracture of the C6 vertebral body with spinal cord compression in an adolescent (case history)
Fractures and dislocation fractures of C5‑Th1 vertebrae account for about 70 % of all spinal injuries. The article describes a case history of the successful treatment of the fractured C6 vertebra by means of spinal fusion with an autogenous bone. The SCT (spiral computed tomography) and MRI (magnetic resonance imaging), performed for diagnostic purposes, showed a splintered fracture of the C6 vertebra with spinal cord compression and mild spinal cord swelling. The clinical picture indicated acute pain in the cervical spine, quadriplegia, and functional disorder of the pelvic organs caused by the severity and level of the injury. The patient underwent two simultaneous surgeries: during the first operation, a fragment of autologous bone from the left iliac wing was taken, and during the second surgery, spinal fusion of C5‑C7 with autologous bone and fixation with a titanium plate were performed. After the interventions, the follow-up SCT of the C-spine showed no signs of spinal cord compression, and the wedge-shaped deformation of the vertebral canal was remedied. No displacement of the vertebral bodies and changes in the height of the vertebrae and vertebral discs is present. After treatment, the patient will undergo long-term rehabilitation measures. The obtained result proves the efficacy of autobone spinal fusion with anterior low-profile titanium plate fixation with four screws. Due to correct and timely medical care provided to the patient, all of the treatment objectives (minimizing secondary injuries of the spinal cord and ensuring optimal conditions for recovery of neurons and axons in the area of disturbed blood supply, spine stabilization) were accomplished.
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