Cybulski G R, Stone J L, Kant R
Division of Neurosurgery, Cook County Hospital, Chicago, Illinois.
Neurosurgery. 1989 Mar;24(3):392-7. doi: 10.1227/00006123-198903000-00014.
Case records of 88 patients with low-velocity gunshot injuries of the terminal spinal cord and cauda equina treated by laminectomy at Cook County Hospital between 1969 and 1987 were reviewed. Sixty-one patients were operated upon within 72 hours of injury, 29 of whom (47.5%) experienced neurological improvement or pain relief. Twenty-seven patients were operated upon at a later time for associated injuries, 13 of whom (48.1%) experienced neurological improvement or pain relief. When laminectomy was delayed for more than 2 weeks, either arachnoid adhesions (15%) or occult abscesses (17%) were observed. From this review as well as from the literature, it appears that the timing of laminectomy for gunshot injuries of the thoracolumbar and lumbosacral spine is not essential to neurological recovery. It appears, however, that adequate debridement of these injuries, performed as soon as the patient is stable from any associated injuries, may help to mitigate the late sequelae of arachnoiditis, infection, and pain syndromes in the lower extremities.
回顾了1969年至1987年间在库克县医院接受椎板切除术治疗的88例终末脊髓和马尾神经低速枪伤患者的病历。61例患者在受伤后72小时内接受了手术，其中29例（47.5%）神经功能得到改善或疼痛缓解。27例患者因相关损伤在后期接受了手术，其中13例（48.1%）神经功能得到改善或疼痛缓解。当椎板切除术延迟超过2周时，观察到蛛网膜粘连（15%）或隐匿性脓肿（17%）。从本次回顾以及文献来看，胸腰段和腰骶段脊柱枪伤行椎板切除术的时机对神经功能恢复并非至关重要。然而，一旦患者从任何相关损伤中稳定下来，尽早对这些损伤进行充分清创，可能有助于减轻蛛网膜炎、感染和下肢疼痛综合征的晚期后遗症。
