Regauer M, Neu J
Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie, Campus Innenstadt, Klinikum der LMU München, Nußbaumstraße 20, 80336 München.
Unfallchirurg. 2013 Mar;116(3):283-5. doi: 10.1007/s00113-012-2327-4.
A 72-year-old female patient was transferred to a rehabilitation centre after surgical stabilization of a subtrochanteric femoral fracture. However, adequate mobilization was not possible there and 5 days after transfer deficits in the motor function of both lower extremities were documented for the first time and an initial paraplegia was diagnosed the following day by a neurologist. Magnetic resonance imaging (MRI) revealed the suspicion of an unstable fracture of the seventh thoracic vertebral body 8 days after the initial symptoms, which was confirmed by computed tomography after another 3 days. Surgical decompression and stabilization were performed at a department for neurosurgery 4 days later but incomplete paraplegia persisted permanently. The patient complained about insufficient diagnostic measures at the rehabilitation centre. The expert opinion concluded that it would have been mandatory to investigate the matter of the newly occurring neurological symptoms immediately but this had only been performed after undue delay, which had to be interpreted as a case of medical malpractice. The expert pointed out that it was not possible to provide clear evidence that emergent diagnosis and surgery would have enabled a significantly better outcome.The arbitration board ascertained a lack of examination and argued that prompt and adequate diagnostic measures would have revealed the relevant pathological finding and thus surgery would have been performed immediately. According to the reversal of evidence in favor of the patient it could be assumed that no permanent neurological damage existed when the first neurological symptoms occurred and that emergent surgery at least had the potential to prevent permanent paraplegia. This opinion of the arbitration board is supported by numerous references in the literature.
一名72岁女性患者因股骨转子下骨折手术固定后被转至康复中心。然而，在那里无法进行充分的活动，转院5天后首次记录到双下肢运动功能缺陷，第二天神经科医生诊断为初始截瘫。磁共振成像（MRI）在初始症状出现8天后显示怀疑第七胸椎椎体不稳定骨折，再过3天后计算机断层扫描证实了这一情况。4天后在神经外科进行了手术减压和固定，但不完全截瘫永久持续。患者抱怨康复中心的诊断措施不足。专家意见得出结论，本应立即调查新出现的神经症状问题，但这只是在不当延迟后才进行，这必须被解释为医疗事故案例。专家指出，无法提供明确证据表明紧急诊断和手术会带来明显更好的结果。仲裁委员会确定存在检查不足的情况，并认为及时和充分的诊断措施本可发现相关病理发现，从而立即进行手术。根据有利于患者的证据倒置，可以假设首次出现神经症状时不存在永久性神经损伤，并且紧急手术至少有可能预防永久性截瘫。仲裁委员会的这一意见得到了文献中的大量参考文献的支持。
