Department of Neurosurgery, Ohio State Medical Center, Columbus, Ohio 43210, USA.
J Neurosurg Spine. 2011 Jul;15(1):60-3. doi: 10.3171/2011.3.SPINE10718. Epub 2011 Apr 1.
Although nail-gun injuries are a common form of penetrating low-velocity injury, impalement with barbed nails has been underreported to date. Barbed nails are designed to resist dislodgment once embedded, and any attempt at removal may splay open the barbs along the path of entry, with the potential for significant soft-tissue and neurovascular injury. A 25-year-old man sustained a nail impalement of the cervical spine from accidental discharge of a nail gun. The patient was noted to be fully conscious with no neurological deficits. Cervical Zone 2 impalement was noted, with only the head of the nail visible. Angiography revealed the nail lying just anterior to the right vertebral artery (VA), with compression of the vessel. Preoperatively, analysis of a similar nail revealed that orientation of the head determined position of the barbs. A deep neck dissection was then performed to the lateral aspect of the C-3 body, using the nail as a guide. Prior to removal, the nail was turned 180° to change the position of the barbs, to prevent injury to the VA. Nail removal was uneventful. The authors present a simple technique for treatment of a nail-gun injury with a barbed nail. Prior to removal, radiographic analysis of the impaled nail must be performed to determine the presence of barbs. If possible, the surgeon should request a similar nail for analysis prior to surgery. Last, the treating surgeon must have knowledge of the barbs' position at all times during nail removal, to prevent damage to critical structures.
虽然钉枪伤是一种常见的穿透性低能损伤形式，但到目前为止，带有倒钩的刺钉伤的报道较少。倒钩钉的设计目的是一旦嵌入就防止脱落，任何移除的尝试都可能使倒钩沿着进入的路径张开，从而导致严重的软组织和神经血管损伤。一名 25 岁男子因意外发射钉枪而导致颈椎刺伤。患者意识完全清醒，无神经功能缺损。发现颈椎 2 区刺伤，只有钉头可见。血管造影显示钉位于右侧椎动脉（VA）前方，血管受压。术前，对类似钉子的分析表明，钉子头部的方向决定了倒钩的位置。然后在 C-3 体的侧面进行了深部颈部解剖，使用钉子作为引导。在移除之前，将钉子旋转 180°以改变倒钩的位置，以防止 VA 损伤。钉子的移除很顺利。作者提出了一种治疗带有倒钩的钉枪伤的简单技术。在移除之前，必须对刺伤的钉子进行影像学分析，以确定是否存在倒钩。如果可能，外科医生应在手术前要求分析类似的钉子。最后，在移除钉子的过程中，治疗外科医生必须始终了解倒钩的位置，以防止对关键结构造成损害。
