Larsen L B, Tollesson G, Solgaard T
Nevrokirurgisk avdeling Ullevål sykehus 0407 Oslo.
Tidsskr Nor Laegeforen. 2001 Feb 10;121(4):434-5.
Problems about penetrating injuries are well known, but spinal cord damage is rare. Stab wounds to the spinal cord may be a new type of injury in our society.
We describe two patients brought to our hospital with stab wounds to the cervicothoracic region and major neurologic injury. One was treated initially only with cleaning and primary closure of the skin. After two weeks the intraspinal damage was repaired in our neurosurgical unit. The second patient was immediately brought to neurosurgery. The intraspinal damage was explored and the dural tear was closed.
The first patient got a superficial infection and spinal fluid leakage after initial treatment. This resolved when the dura was closed. There were no wound complications in the second patient. Both demonstrated Brown-Séquard's syndrome. Neurologic recovery was much better in the first than in the second patient.
Minor penetrating wounds in the neck region may represent damage to the spinal cord with major neurologic injury. Further investigation with MR is preferable and we recommend immediate surgical treatment with closure of the dural tear.
穿透伤问题广为人知,但脊髓损伤较为罕见。脊髓刺伤在我们的社会中可能是一种新型损伤。
我们描述了两名因颈胸段刺伤并伴有严重神经损伤被送至我院的患者。其中一名患者最初仅接受了伤口清洁和皮肤一期缝合处理。两周后,在我们的神经外科对其脊髓内损伤进行了修复。第二名患者被立即送往神经外科。对其脊髓内损伤进行了探查并缝合了硬脊膜撕裂处。
第一名患者在初始治疗后出现了浅表感染和脑脊液漏。当硬脊膜闭合后,这些问题得到了解决。第二名患者未出现伤口并发症。两名患者均表现出布朗 - 塞卡尔综合征。第一名患者的神经恢复情况比第二名患者好得多。
颈部的轻微穿透伤可能意味着伴有严重神经损伤的脊髓损伤。最好进一步进行磁共振成像检查,我们建议立即进行手术治疗并缝合硬脊膜撕裂处。