Anegawa S, Nakashima H, Torigoe R, Furukawa Y
Neurol Med Chir (Tokyo). 1989 Aug;29(8):777-81. doi: 10.2176/nmc.29.777.
A 56-year-old female sustained a neck laceration by a piece of glass, which broke when she fell backward. She immediately became quadriplegic and was transported to a local hospital, then deteriorated and was referred to the authors' hospital. Neurological examination revealed quadriplegia that was particularly pronounced in the right arm and left leg. Pain sensation was decreased in the right upper and lower extremities below the C3 level. Cervical spine films showed glass fragments in the gap between the occipital bone and the C1 arch. Computed tomography dramatically demonstrated glass fragments that had become fixed in the spinal cord at the spinomedullary transition. A suboccipital craniectomy and C1 laminectomy allowed visualization of the dural laceration. Opening of the dura exposed a glass fragment penetrating the upper cervical spine just caudal to the left tonsil. It was successfully removed with a hemostat clamp. Postoperatively, the patient was soon able to walk without assistance. To the authors' knowledge, upper cervical spinal cord injury caused by glass has previously been reported only twice, although broken glass is a common cause of wounds. Also, this patient exhibited signs of "hemiplegia cruciata," which is thought to be due to damage to the pyramidal decussation.
一名56岁女性因一块玻璃造成颈部撕裂伤，这块玻璃在她向后摔倒时破碎。她立即出现四肢瘫痪，被送往当地医院，随后病情恶化，被转诊至作者所在医院。神经学检查显示四肢瘫痪，右臂和左腿尤为明显。C3水平以下的右上肢和下肢痛觉减退。颈椎X线片显示枕骨与C1椎弓之间的间隙有玻璃碎片。计算机断层扫描清楚地显示玻璃碎片已固定在脊髓延髓交界处。枕下颅骨切除术和C1椎板切除术使硬脑膜撕裂得以显露。打开硬脑膜后发现一块玻璃碎片穿透上颈椎，恰好在左侧扁桃体下方。用止血钳成功取出。术后，患者很快就能独立行走。据作者所知，玻璃导致上颈椎脊髓损伤此前仅报道过两例，尽管碎玻璃是常见的伤口原因。此外，该患者表现出“交叉性偏瘫”的体征，这被认为是由于锥体交叉受损所致。
