Điều trị chấn thương cột sống thấp cơ chế cúi - căng - xoay bằng phẫu thuật Bohlman cải tiến

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TIẾNG PHÁP

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PHỤ LỤC 2

CÁC TRƯỜNG HỢP MINH HỌA

Trường hợp 1.

Họ tên: Tr.V. H, Tuổi: 63, Phái: Nam.

Địa chỉ: 639D Nguyễn trãi, P11, Q5, TP. HCM. Số hồ sơ: 459/2003. (Bệnh án số: 26).

Thời gian vào viện: 15 ngày. Thời gian đến lúc mổ: 25 ngày. Thời gian nằm viện: 12 ngày. Thời gian theo dõi: 102 tháng.

Nguyên nhân tai nạn: Tai nạn sinh hoạt. Cơ chế chấn thương: Cơ chế cúi.

Bệnh sử: Ngày 11-9-2003 té cao 1,5mm, va chẩm vào tường. Đau đơ cổ, không tổn thương thần kinh. X quang không thấy tổn thương. X quang cắt lớp điện toán cũng không phát hiện tổn thương. Được chẩn đoán là chấn thương phần mềm CSC. Điều trị thuốc giảm đau và đeo nẹp cổ. 2 tuần sau đau cổ nhiều hơn. Không

tổn thương thần kinh và X quang kiểm tra thấy di lệch C5 – C6 ra trước 4mm, gập góc + 220.

Chẩn đoán lâm sàng: Bong gân nặng C5 – C6. Frankel E.

Phương pháp phẫu thuật: Bohlman cải tiến (Chỉ 0,6mm dùng néo ép 2 mỏm gai và cố định mảnh xương ghép).

Kết quả điều trị: Nắn xương hoàn hảo, hết di lệch hoàn toàn. Góc gù - 20. Phục

hồi đường cong sinh lý CSC. Frankel E.

Liền xương độ I.

Độ đau VAS = từ 5  0 điểm.

Bệnh án này nhằm minh họa cho sự mất vững của tổn thương do bong gân nặng CSC thấp.

CT-SCAN SAU CHẤN THƯƠNG:

Không thấy tổn thương, ngang tầng C5-C6 bình thường

2 TUẦN SAU ĐIỀU TRỊ BẢO TỒN

Di lệch thứ phát ngang tầng C5-C6