Hoey Alexander, Troy Christopher, Bauerle Wayne, Xia Anthony, Hoey Brian
Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, United States.
Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.
J Neurol Surg Rep. 2022 Jun 24;83(2):e54-e62. doi: 10.1055/s-0042-1749650. eCollection 2022 Apr.
Nail gun use and its associated incidence of injury have continued to increase since it was first introduced in 1959. While most of these injuries involve the extremities, a subset of patients suffer intracranial trauma. The most recent comprehensive review on this particular subject referenced 41 cases and advocated for further discussion regarding proper treatment plans for these individuals. We present the case of a 25-year-old who suffered 35 self-inflicted penetrating head wounds from a nail gun after suffering an amputation injury at his job site. No neurological deficits were present on his arrival to the emergency room. He underwent surgery to treat his arm wound and remove 13 of the 35 nails. The patient was discharged from the hospital on levetiracetam and made a full recovery. Nearly 1 year later, he experienced a seizure at his workplace. However, after resuming his antiepileptic medication, he reports no further complications. This case is distinct for not only being the most nails in a patient's head at presentation, but also following surgery. Utilizing this case, prior review, and 27 subsequent cases, we propose an updated algorithm for diagnosis and treatment of nail-gun-related penetrating head trauma.
自1959年首次引入以来，钉枪的使用及其相关伤害发生率持续上升。虽然这些伤害大多累及四肢，但有一部分患者会遭受颅内创伤。最近关于这一特定主题的全面综述引用了41个病例，并主张对这些患者的适当治疗方案进行进一步讨论。我们报告一例25岁患者，其在工作场所遭受截肢伤后，用钉枪自伤头部，造成35处贯通伤。他到达急诊室时没有神经功能缺损。他接受了手术治疗手臂伤口，并取出了35枚钉子中的13枚。患者出院时服用左乙拉西坦，完全康复。将近1年后，他在工作场所癫痫发作。然而，在恢复抗癫痫药物治疗后，他报告没有进一步的并发症。该病例不仅在就诊时患者头部钉子数量最多，而且在手术后也是如此，因而具有独特性。利用该病例、先前的综述以及随后的27个病例，我们提出了一种更新的钉枪相关贯通性头部创伤的诊断和治疗算法。
