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Abstract: Burst fractures are mostly seen in the thoracic and lumbar spine, and are a serious traumatic fracture, mostly caused by strong violence such as car accidents or falls from height. The patient in this case was a thoracic vertebral burst fracture caused by a car accident, which not only damaged the spinal cord leading to paralysis of both lower limbs, but also punctured the left pleura leading to left pneumothorax. After timely resuscitation and treatment, the patient’s respiratory function returned to normal and sensory function of both lower limbs was partially restored.
Basic information】Male, 18 years old
Disease Type】Thoracic vertebral burst fracture
Hospital】The First Hospital of Harbin Medical University
Consultation time】December 2021
Treatment plan】Thoracic closed drainage + thoracic posterior repositioning of the vertebral plate decompression fusion internal fixation + acupuncture and electrical stimulation treatment
Treatment period】Inpatient treatment for 14 days, transferred to rehabilitation hospital for further treatment
Treatment effect] The patient’s respiratory function was normalized and the sensory function of both lower limbs was partially restored.
I. Initial consultation
The patient was a survivor of a car accident and was transferred to Harbin from overseas overnight. The patient was sitting in the back row of the vehicle, and the whole person flew out directly under inertia when he was injured, and he lost consciousness. The diagnosis of thoracic vertebral burst fracture and complete fracture dislocation of the spine could be clearly diagnosed through imaging examination, and the displaced vertebrae even pierced the adjacent pleura leading to left-sided pneumothorax.
II. Treatment history
Vital signs were measured in the emergency room, oxygen saturation was 84%, heart rate was 110 beats/min, blood pressure was 110/80 mmHg, and the thoracic surgery department was asked to place closed drainage in the left thoracic cavity. After admission, the patient was advised to abstain from food and water, continuously monitor vital signs, and complete thoracolumbar frontal and lateral X-ray, 3D reconstruction of thoracic spine CT and thoracic spine nuclear magnetic examination. At the same time, preoperative examinations such as vascular ultrasound of both lower limbs, electrocardiogram, routine blood count and coagulation were completed. The incision was changed every other day after surgery, and the stitches were removed 2 weeks after surgery. The patient was given paraplegic care immediately after surgery to prevent the formation of pressure sores, and was given acupuncture and electrical stimulation treatment 1 week after surgery. The patient was discharged from the hospital in 14 days and transferred to a rehabilitation hospital for further treatment.
III. Treatment effect
On the 2nd day after surgery, the patient’s respiratory function returned to normal, the spinal pain in the thoracic back was relieved, the incision was mildly painful, and the pain improved 5 days after surgery. On the 7th day after surgery, he felt numbness in both lower extremities, which seemed to have a sense of discharge, and he felt soreness and swelling in both lower extremities at night when he slept, but he did not feel the skin when he touched it. On the 14th day after surgery, he felt a mild sensation of holding when urinating. One month after the operation, both lower limbs had sensation when touched, but the sensation was dull and the pain stimulus was not sensitive.
IV. Precautions
After treatment, the patient’s sensory function of both lower extremities was partially restored, which was a relief to the treating physician. The patient’s spinal cord was injured due to a thoracic burst fracture dislocation, causing bilateral lower limb paralysis, and the recovery of neurological function after surgery was very slow, so for this patient, the most important thing after surgery is to pay attention to paraplegia care. Therefore, the patient’s family was instructed to, first of all, take care of the patient’s skin to avoid pressure sores and perform regular turning and massage, also using air beds and bed sore patches. Regularly change the urinary catheter, flush the urethra to prevent urinary tract infection, regularly turn and tap the back, and discharge sputum in time to prevent and control respiratory tract infection. Finally, regular massage of the lower extremities should be performed to prevent deep vein thrombosis. In addition, the fractures need to be reviewed by regular radiographs.
V. Personal insight
A burst fracture is a very serious fracture, and for this patient, although the spinal cord injury caused by the burst fracture of the thoracic spine was not so severe as to affect the respiratory and circulatory functions, the injury to the spinal cord in the corresponding location was equally severe with such a severe displacement, and even if the surgery was completed in the fastest and best way, the function of the patient’s lower extremities would be affected for life. However, the good thing is that the patient has already developed some sensory function in both lower extremities, so the subsequent active rehabilitation treatment will promote the restoration of lower extremity mobility.