中国神经再生研究(英文版) ›› 2023, Vol. 18 ›› Issue (12): 2781-2784.doi: 10.4103/1673-5374.373668

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木钉急性穿透性损伤脊髓的延迟手术干预:病例报告

  

  • 出版日期:2023-12-15 发布日期:2023-06-16

Acute penetrating injury of the spinal cord by a wooden spike with delayed surgery: a case report

James D. Guest1, *, Zhuojing Luo3, Yansheng Liu4, Hongkun Gao2, Dianchun Wang2, Xiao-Ming Xu5, Hui Zhu2   

  1. 1Neurological Surgery, and the Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL, USA; 2Kunming International Spine, and Spinal Cord Injury Treatment Center, Kunming Tongren Hospital, Kunming, Yunnan Province, China; 3Department of Orthopedic Spinal  Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi Province, China; 4Department of Neurosurgery, Kunming Tongren Hospital, Kunming, Yunnan Province, China; 5Indiana University School of Medicine, Stark Neurosciences Research Institute, Indianapolis, IN, USA
  • Online:2023-12-15 Published:2023-06-16
  • Contact: James D. Guest, MD, PhD, FAANS, jguest@med.miami.edu.

摘要:

木质物体造成的脊髓穿透性损伤较为罕见,其引发的感染和异物反应的发生率很高。文章报告了1例被一根削尖的棍子刺穿颈椎的男性病例。虽然最初是四肢瘫痪,但他迅速恢复了功能。尽管脊髓被刺穿,但手术切除时神经系统恶化的风险使患者不愿意同意手术。第3天的核磁共振成像显示水肿扩大,表明有进行性炎症。在受伤后第7天,患者出现了发烧和麻痹,血清炎症指标大幅上升,患者同意接受手术切除木质物体。文章讨论了与木头有关的管理、MRI结果的纵向演变、感染风险、手术风险和技术、炎症标志物及长期恢复,以及与低速中线脊髓损伤相关的令人惊讶的最小神经功能障碍。该患者的临床结果非常好。主要的教训是,木质穿透性中枢神经系统损伤有很高的感染风险,手术切除脊髓应在伤后不久并在直视下进行。

https://orcid.org/0000-0003-0931-0286 (James D. Guest)

Abstract: Rarely, penetrating injuries to the spinal cord result from wooden objects, creating unique challenges to mitigate neurological injury and high rates of infection and foreign body reactions. We report a man who sustained a penetrating cervical spinal cord injury from a sharpened stick. While initially tetraparetic, he rapidly recovered function. The risks of neurological deterioration during surgical removal made the patient reluctant to consent to surgery despite the impalement of the spinal cord. A repeat MRI on day 3 showed an extension of edema indicating progressive inflammation. On the 7th day after injury, fever and paresthesias occurred with a large increase in serum inflammatory indicators, and the patient agreed to undergo surgical removal of the wooden object. We discuss the management nuances related to wood, the longitudinal evolution of MRI findings, infection risk, surgical risk mitigation and technique, an inflammatory marker profile, long-term recovery, and the surprisingly minimal neurological deficits associated with low-velocity midline spinal cord injuries. The patient had an excellent clinical outcome. The main lessons are that a wooden penetrating central nervous system injury has a high risk for infection, and that surgical removal from the spinal cord should be performed soon after injury and under direct visualization. 

Key words: case report, interleukin-6, magnetic resonance imaging, penetrating, spinal cord injury, wood