Gueye E M, Sakho Y, Badiane S B, Ba M C, Diene M S, Diop A A, Gueye M
Service de Neurologie, CHU Fann, Dakar, Sénégal.
Dakar Med. 1998;43(2):238-42.
Penetrating spinal cord injuries (P.S.C.I.) are rarely described in Sub Saharian countries in spite of an increasing number of wars. To study epidemiology management and prognosis of P.S.C.I. in Senegal, population of 16 patients collected from Fann Hospital in Dakar has been studied. 9 cases were related on gunshot or shrapnel injuries and 6 were stab-wounded. 8 came from war practice and 7 from civilian practice. The point of entry was at the posterior or lateral part of the body and continuous leaking of cerebral spinal fluid from this point was founded only in one patient. Patients showed a clinical picture of a complete spinal cord section syndrome, 3 spinal cord hemisection Brown Sequard syndromes, 3 cauda equina syndromes and 1 monoradicular syndrome. Spinal X-rays or myelography may lead to an accurate evaluation of the extent of bone tissue destruction. Anatomical evaluation of roots and spinal cord lesions were more difficult when C.T. scan or R.M.I. is not available. Penetrating spinal cord injury with foreign body included or myelography stop or showing cauda equina syndrome should be operated on. 9 of our patients has benefited of spine surgical posterior approach (laminectomy). Immediate vital prognosis is good regarding the fact that visceral associated lesions were rare (2 cases). Functional recovery is fair only 46.6% of patients expressed partial or complete recovery. Prognosis factors such as injuring agent and initial neurological status has been discussed. Prognosis of penetrating spinal cord injuries could be improved by immediate and multidisciplinary management.
尽管撒哈拉以南国家的战争数量不断增加，但穿透性脊髓损伤（P.S.C.I.）的描述却很少。为了研究塞内加尔穿透性脊髓损伤的流行病学、管理和预后，对从达喀尔法恩医院收集的16例患者进行了研究。9例与枪伤或弹片伤有关，6例为刺伤。8例来自战争，7例来自平民。损伤入口位于身体后部或侧面，仅1例患者出现从此处持续脑脊液漏。患者表现出完全脊髓横断综合征、3例脊髓半横断布朗 - 塞卡尔综合征、3例马尾综合征和1例单神经根综合征的临床表现。脊柱X光或脊髓造影可准确评估骨组织破坏程度。当没有CT扫描或MRI时，对神经根和脊髓损伤的解剖学评估更加困难。伴有异物的穿透性脊髓损伤、脊髓造影中断或显示马尾综合征的患者应进行手术。我们的9例患者接受了脊柱后路手术（椎板切除术）。鉴于内脏相关损伤很少见（2例），即时生命预后良好。功能恢复情况一般，只有46.6%的患者部分或完全恢复。讨论了诸如致伤因素和初始神经状态等预后因素。即时和多学科管理可改善穿透性脊髓损伤的预后。
