Arévalo J M, Lorente J A, Balseiro-Gómez J
Servicio de Cirugía Plástica y Quemados, Hospital Universitario de Getafe, Madrid, Spain.
Burns. 1999 Aug;25(5):449-52. doi: 10.1016/s0305-4179(98)00193-4.
To analyse the incidence, diagnosis and outcome of spinal cord injury in patients with electrical injuries.
Retrospective analysis of patients with electrical injuries admitted to our Intensive Care Burn Unit over a 5 year period. Among 435 admissions, 57 (13.1% of all admissions) were electrical injuries, due to either electrical flash (n = 34) or high voltage (n = 23). Two cases (8.6% of high voltage injuries) presented signs of spinal cord injury. Both cases presented an acute transverse myelopathy, involving the pyramidal tract, the posterior cords and the spinothalamic tract, causing a pyramidal syndrome with abnormal sensation and involvement of posterior cords, one with paraplegia and the other one with quadriplegia. Diagnoses were made 1 and 2 weeks after admission, respectively, when sedation was discontinued and neurological signs could be appreciated. Computerised axial tomography and nuclear magnetic resonance were normal in both cases at the moment of diagnosis. Both patients experienced a slow but progressive improvement of their neurological condition, and remain presently in a rehabilitation program 15 and 18 months after trauma.
Our cases illustrate (i) that damage to the spine is not infrequent after electrical injury, (ii) the difficulty in making the diagnosis of spinal cord injury after electrical trauma, and (iii) the importance of early diagnosis to define neurological prognosis and start available therapies as soon as possible.
分析电损伤患者脊髓损伤的发生率、诊断及预后情况。
对我院重症烧伤监护病房5年内收治的电损伤患者进行回顾性分析。435例住院患者中，57例（占所有住院患者的13.1%）为电损伤，其中电灼伤34例，高压电损伤23例。2例（占高压电损伤患者的8.6%）出现脊髓损伤体征。两例均表现为急性横贯性脊髓病，累及锥体束、后索和脊髓丘脑束，导致锥体综合征伴感觉异常及后索受累，1例为截瘫，另1例为四肢瘫。分别在入院后1周和2周，停用镇静剂且能明确神经体征时作出诊断。诊断时，两例患者的计算机断层扫描和核磁共振检查均正常。两名患者的神经功能均缓慢但持续改善，目前在受伤后15个月和18个月仍在接受康复治疗。
我们的病例表明，（i）电损伤后脊柱损伤并不罕见；（ii）电创伤后脊髓损伤的诊断存在困难；（iii）早期诊断对于确定神经预后并尽快开始可行治疗至关重要。
