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題 名 | Successful Treatment with Long-Segmental Transpedicular Screws for a Psychiatric Patient with Lumbar Spinal Fracture Dislocation=利用長節數鋼釘手術治療精神病患者跳樓自殺致腰椎骨折性脫位 |
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作 者 | 洪恭誠; 夏中慶; 蔣永孝; 林欣榮; | 書刊名 | Journal of Medical Sciences |
卷 期 | 22:5 2002.10[民91.10] |
頁 次 | 頁235-238 |
分類號 | 416.61 |
關鍵詞 | 精神病患; 跳樓自殺; 腰椎骨折性脫位; Cauda equina syndrome; Fracture-dislocation; Lumbar spine; Psychiatric; Suicide; |
語 文 | 英文(English) |
英文摘要 | In the management of one-level thoracolumbar fracture, we usually perform surgical fixation with short-segmental transpedicular screws. However, for post-operative care of psychiatric patients, patient's restlessness should be considered. We present a 26-year-old single female, who had history of bipolar disorder, followed by a suicide attempt jumping from the 5th floor. A neurological examination revealed acute cauda equine syndrome, and the neurological status was categorized as Frankel B. The lumbar spine X-ray revealed a burst fracture of L2 with fracture-disloction and kyphotic deformity. The L2 vertebral body was collapsed to less than 30% of normal height. Computed tomography demonstrated burst fracture of the 2nd lumbar with severe compression of the thecal cavity. She received operation with long-segmental transpedicular screws (two above and two below the fracture site) on an emergency basis. The finding of the post-operative X-film showed good reduction, L2 vertebral body restoration and nearly normal lordotic curvature of lumbar spine. After having received a course of physical therapy at our rehabilitation division for 6 weeks, her neurological status recovered to Frankel B. She was then transferred to psychiatric ward for further treatment after receiving a one-month course of the rehabilitation program. Six months after surgery, her neurological status had improved to the level of Frankel E without neurogenic bladder. The finding of her L-spine X-ray examination showed excellent restoration of L2 vertebral body height, improved lordotic curve, and successful fusion of the lumbar spine. |
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