- 期刊
脊椎邊緣骨折合併椎間盤突出：病例報告
Limbus Vertebral Fracture Associated with Herniated Intervertebral Disc: A Case Report
摘要
脊椎邊緣骨折是椎間盤的核疝脫進入椎骨體終板而形成單個或數個骨折碎片，其好發於青少年及年輕成年人，臨床症狀類似急性椎間盤突出伴有下背痛與神經根病變，文獻指出超過一半病患其致病原因與傷害有極大相關；傳統影像學檢查診斷率較低，而電腦斷層掃描是一項可提供正確診斷的工具，在治療方面，手術切除雅問盤軟骨及取出骨折碎片，可確保疾病治癒。 本個案是一位39歲的男性，抱怨下背痛而且會有疼痛傳導到右側臀部。住院前一週病患出現漸進性的神經缺損徵兆，且磁振共振影像顯示第五腰椎邊緣骨折及第五腰椎與第一薦椎間有軟骨突出情形，經椎間盤軟骨及椎板切除術減壓，取出一塊三公分大小未骨化碎片，術後病患的症狀改善，恢復情況良好。脊椎邊緣骨折造成下背痛或神經根病變並不常見，但正確的診斷與適度的治療，可以增加疾病治癒的機會以避免不必要的醫療支出。
並列摘要
Limbus vertebral fracture results from the herniation of disc material into a vertebral body, and in the formation of one or more isolated bony fragments. It is mostly found in adolescents and young adults. Clinically it resembles an acute disc prolapse with low back pain and radiculopathy. Trauma plays a significant etiologic role in up to one half of cases reported in the literature. The diagnosis of limbus vertebral fracture can rarely be based on conventional radiographs. CT scan shows the fracture fragments in most cases and should be considered the most accurate procedure. Complete discectomy with removal of bony fragments assures cure. Here we report a case in a 39-year-old man who complained of low back pain radiating to the right buttock. Over the past one week, he developed progressive neurological deficit. Spine MRI identified L5-S1 disc herniation associated with L5 limbus vertebral fracture. After disectomy and laminectomy, a piece of non-ossified fragment measuring 3 cm was removed. Post-operatively, the patient's symptoms resolved and the patient had an excellent outcome. In conclusion, limbus vertebral fracture resulting in low back pain or radiculopathy is not common. Appropriate examination and treatment offer the chance for cure.
延伸閱讀
- Feng, C. C. (2013). 脊椎骨髓炎合併椎旁膿腫：個案報告. 中華民國急救加護醫學會雜誌, 24(3), 94-100. https://www.airitilibrary.com/Article/Detail?DocID=10232214-201309-201409100002-201409100002-94-100
- Lan, S. M., Huang, K. Y., & Lin, R. M. (2009). 跌倒所致之腰椎後外側融合體骨折：一病例報告. Journal of Orthopaedic Surgery Taiwan, 26(1), 27-32. https://www.airitilibrary.com/Article/Detail?DocID=10116923-200903-26-1-27-32-a
- Yeh, H. M., & Lin, Y. J. (2021). 僵直性脊椎炎病患雙處脊椎彎曲伸展型骨折－個案報告. Formosan Journal of Rheumatology, 35(2), 70-74. https://doi.org/10.6313/FJR.202112_35(2).0009
- Lin, C. Y., Lee, C. H., Tsuang, Y. H., & Kuo, Y. J. (2017). 雙側椎弓根壓力性骨折發生在腰椎融合與椎體成形術後的類風濕關節炎病人－病例報告. 北市醫學雜誌, 14(1), 79-84. https://doi.org/10.6200/TCMJ.2017.14.1.07
- Wu, S., Tsuang, Y. H., Hwang, Y. F., Chen, P. Q., & Shih, T. T. F. (1995). Intraspinal Cystic Lesion from Intervertebral Disc – A Case Report. Journal of Orthopaedic Surgery Taiwan, 12(1), 65-67. https://www.airitilibrary.com/Article/Detail?DocID=10116923-199502-12-1-65-67-a