Darwazeh Rami, Darwazeh Mazhar, Elzain Mohammed Awad, Al-Kanash Rasha
Department of Neurosurgery, Arab Women's Union Hospital, Nablus, Palestine.
Department of Neurosurgery, Arab Women's Union Hospital, Nablus, Palestine.
Neurocirugia (Engl Ed). 2023 Jan-Feb;34(1):44-47. doi: 10.1016/j.neucie.2022.11.016.
A 10-year-old boy presented to neurosurgery department after a gunshot wound to the upper thoracic spine. The bullet entered through the right deltoid muscle and lodged inside the spinal canal at T1 level. The patient arrived conscious and obeying commands; however, he experienced a loss of sensation below T3 level, loss of reflexes below the injured T1 level, loss of anal sphincter tone and paraplegia in the lower limbs (American Spinal Injury Association grade-A). Imaging studies revealed an intra-canalicular metallic bullet at the T1 level. The patient underwent urgent operation using a tubular retractor system and the microscope. Subsequently, the bullet was successfully retrieved. Postoperatively, the patient made a significant recovery and by the end of the 6th month, he was able to walk independently despite some gait instability. A minimally invasive approach for intra-canalicular bullet removal in the thoracic region is a safe and effective technique in pediatric patients.
一名10岁男孩因上胸椎枪伤被送至神经外科。子弹经右三角肌进入，停留在T1水平的椎管内。患者就诊时意识清醒，能听从指令；然而，他T3水平以下感觉丧失，受伤的T1水平以下反射消失，肛门括约肌张力丧失，下肢截瘫（美国脊髓损伤协会A级）。影像学检查显示T1水平椎管内有一枚金属子弹。患者使用管状牵开器系统和显微镜接受了紧急手术。随后，子弹被成功取出。术后，患者恢复良好，到第6个月末，尽管步态有些不稳，但他已能独立行走。在小儿患者中，采用微创方法取出胸段椎管内子弹是一种安全有效的技术。
