Bhatoe H S, Singh P
Department of Neurosurgery, Army Hospital (R & R), Delhi Cantt-110010, India.
Neurol India. 2003 Dec;51(4):507-11.
Between 1995 and 2000, 22 cases with low velocity missile injuries of the spine and spinal cord were treated in three service hospitals. All were adult males, with a mean age of 30.7 years. The wounds were caused by splinters in 18 (82%) and bullets in 4 (18%). Twelve patients received more than one splinter. The cervical and thoracic spines were most frequently involved. In 7 cases, there were injuries to other organs. There was extensive initial deficit (quadriplegia, paraplegia) in 18 (82%) cases, while 4 (18%) had partial deficits. The patients were evaluated by spine radiographs. Myelography was done in 4, CT myelography in 11 and MRI in 4 patients. Two patients had intramedullary hematoma without any skeletal injury, and were treated conservatively. Seventeen patients were treated operatively, and associated injuries of other organs received priority management. Surgery was in the form of debridement, exploration of the spinal cord, hemostasis, decompression and dural repair. Steroids and antibiotics were given routinely. Three patients (2 with cervical and 1 with thoracic spine injury) died preoperatively, and 1 (with dorsolumbar injury) died in the postoperative period due to multi-organ injury. Patients with complete injury remained completely paralyzed, while those with an incomplete injury showed improvement in their neurological grades. The initial neurological grade is the best prognostic indicator, and these injuries are often accompanied by multi-organ injuries. There was no instance of postoperative meningitis or CSF leak. These injuries should be explored for debridement and dural repair.
1995年至2000年间，三家军队医院共收治了22例低速导弹致脊柱和脊髓损伤的患者。所有患者均为成年男性，平均年龄30.7岁。其中18例（82%）为碎片伤，4例（18%）为子弹伤。12例患者有多处碎片伤。颈椎和胸椎最常受累。7例患者合并其他器官损伤。18例（82%）患者伤后初期有严重神经功能缺损（四肢瘫、截瘫），4例（18%）有部分神经功能缺损。患者均行脊柱X线检查。4例行脊髓造影，11例行CT脊髓造影，4例行MRI检查。2例患者无骨骼损伤但有脊髓内血肿，予以保守治疗。17例患者接受了手术治疗，其他器官的合并伤优先处理。手术方式包括清创、脊髓探查、止血、减压及硬脊膜修补。常规给予类固醇和抗生素。3例患者（2例颈椎损伤，1例胸椎损伤）术前死亡，1例（胸腰段损伤）术后因多器官损伤死亡。完全性损伤患者仍完全瘫痪，不完全性损伤患者神经功能分级有所改善。伤后初期神经功能分级是最佳预后指标，这些损伤常合并多器官损伤。术后无1例发生脑膜炎或脑脊液漏。对于这些损伤应行清创及硬脊膜修补术。
