Rubin G, Tallman D, Sagan L, Melgar M
Section of Neurosurgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona 85724, USA.
Spine (Phila Pa 1976). 2001 Feb 15;26(4):444-7. doi: 10.1097/00007632-200102150-00023.
A rare case of a laterally directed stab wound injury of the cervical spinal cord is reported.
To describe the unusual mechanism of injury of this case and its clinical features. The surgical indications for penetrating injuries of the spinal cord are discussed.
Spinal stab wound injuries are rare, and the literature on the subject is scant. There has been only one large clinical review from South Africa, published in 1977. The clinical features and the injury mechanism of a laterally directed stab wound to the cervical spine have not been previously described.
An 18-year-old man was stabbed in the right side of the neck at C1-C2. The blade penetrated the spine laterally and went through the ligaments without affecting the bony structures. On admission the patient had tetraplegia and was in respiratory failure. Radiologic investigation showed the retained blade passing through the cord but showed no bony or vascular injuries.
Before extraction, the knife was followed to its tip with careful dissection. Because no cerebrospinal fluid leak was noted in the area, the dura was not exposed. After surgery, magnetic resonance images showed a complete transection of the spinal cord at C1-C2. The patient was neurologically unchanged in follow-up examinations.
Laterally directed horizontal stab wounds of the spine are particularly dangerous because the blade can pass between two vertebrae to transect the cord. The neurologic injury that results is irreversible. The more common stab wounds, inflicted from behind, usually produce incomplete cord damage.
报告一例罕见的颈脊髓外侧刺伤病例。
描述该病例不寻常的损伤机制及其临床特征。讨论脊髓穿透伤的手术指征。
脊髓刺伤罕见，相关文献匮乏。1977年南非仅发表过一篇大型临床综述。此前尚未描述过颈椎外侧刺伤的临床特征和损伤机制。
一名18岁男性在C1 - C2水平右侧颈部被刺伤。刀片从侧面穿透脊柱，穿过韧带，未累及骨质结构。入院时患者四肢瘫痪且呼吸衰竭。影像学检查显示残留刀片穿过脊髓，但未发现骨质或血管损伤。
在取出刀片前，通过仔细解剖追踪到刀尖。因该区域未发现脑脊液漏，未暴露硬脑膜。术后磁共振成像显示C1 - C2水平脊髓完全横断。随访检查中患者神经功能无变化。
脊柱外侧水平刺伤尤其危险，因为刀片可在两个椎体之间穿过并横断脊髓。由此导致的神经损伤是不可逆的。更常见的从后方刺入的刺伤通常造成不完全性脊髓损伤。
