创伤性腰5椎体完全性前脱位一例及文献复习

Traumatic complete anterior dislocation at the lumbosacral junction:a case report and literature review

目的报道1例少见的创伤性L5椎体完全性前脱位病例,并结合文献探讨其临床特点、发生机制及治疗策略。方法回顾性分析1例52岁女性创伤性L5椎体完全性前脱位患者的临床资料。在中国知网、万方数据、维普及PubMed等数据库中,以"创伤性腰骶椎完全性脱位""创伤性腰骶椎完全性滑脱"和"traumatic complete lumbosacral dislocation""traumatic lumbosacral spondyloptosis"为中英文关键词,检索2019年1月前有关L5椎体创伤性完全性前脱位的相关文献,共纳入10篇10例L5椎体创伤性完全性前脱位的英文文献报道。结合本例诊治过程,总结该损伤的临床及影像学表现、损伤原因及治疗方法。结果本文1例成年女性因交通事故致L5椎体完全性前脱位伴神经损伤,行单纯后路减压、复位及椎间植骨融合术,术后完全复位,随访6个月复位无丢失,内固定物无松动,患者神经功能基本恢复正常。结合文献报道的10例,共11例创伤性L5椎体完全性前脱位,男9例、女2例,年龄18~57岁,多由高能量暴力伤导致腰骶部肿胀、疼痛、活动受限及不同程度神经功能损伤;影像学提示L5椎体相对于骶骨椎体前移超过100%,多合并脊柱后方附属结构破坏;治疗多提倡早期手术减压、复位、内固定植骨融合术以重建腰骶段稳定性及改善神经功能状态。结论急性创伤性L5椎体完全性前脱位临床较为罕见,生物力学极不稳定,且多合并神经损伤。其发生机制尚存争议。早期采取手术减压、复位及融合有助于改善预后。尽管需根据具体情况采取具体手术方式,但单纯后路减压复位椎间植骨融合内固定术是处理创伤性L5椎体完全性前脱位的一种安全、有效术式。

Objective To report a case of traumatic complete anterior dislocation at the lumbosacral junction and the related literatures were reviewed to explore the clinical characteristics,mechanism and treatment strategy of this pattern injury.Methods The clinical data of a 52-year-old woman with traumatic complete anterior dislocation at the lumbosacral junction were retrospectively analyzed.The literatures about traumatic complete anterior dislocation at the lumbosacral junction before January 2019 were searched in CNKI,Weipu,Wanfang and PubMed database by using"创伤性腰骶椎完全性脱位""创伤性腰骶椎完全滑脱"and"traumatic complete lumbosacral dislocation","traumatic lumbosacral spondyloptosis"as key words.A total of 10 English literatures on 10 cases of lumbar 5 vertebral traumatic complete anterior dislocation were included.The clinical features,imaging features,cases of this pattern injury,treatment and clinical prognosis of 10 cases in literatures and 1 case in this paper were summarized and analysed.Results A case of adult female with complete anterior lumbar dislocation and nerve injury due to traffic accident was reported.Simple posterior decompression,reduction and interbody fusion operation were performed.The lumbosacral dislocation was reduced completely after operation.At the follow-up of 6 months after surgery,no loss of reduction and internal fixator were found,and the neurological function of the patients was nearly normal.Eleven cases of traumatic complete anterior dislocation at the lumbosacral junction were involved,including 1 case in this paper and 10 cases reported.There were 9 males and 2 females,age ranged from 18 to 57 years old.Most of them were caused by high-energy violent injuries,which resulted in lumbosacral swelling,pain,activity limitation and neurological deficits.Radiologic imaging showed that the L5 displaced more than 100%anteriorly relative to the sacrum,and most of them were accompanied by posterior spine accessory structure destruction.Operative management consisted of early surgical decompression,reduction,instrumented spinal fusion to restore the stability of lumbosacral segment and improve the neurological function.Conclusions Traumatic complete anterior dislocation at the lumbosacral junction is a rare injury pattern.Its biomechanics is extremely unstable,and most of them are accompanied by neurological deficits.Its mechanism is still controversial.Early surgical decompression,reduction and fusion can improve the prognosis.Although specific surgical methods should be adopted according to specific conditions,posterior decompression,reduction,interbody fusion and internal fixation is a safe and effective method for complete traumatic anterior lumbosacral joint dislocation.