Romanick P C, Smith T K, Kopaniky D R, Oldfield D
J Bone Joint Surg Am. 1985 Oct;67(8):1195-201.
We reviewed the cases of twenty patients who had a fracture or disruption of the disc space of a lower thoracic or lumbar vertebra that was associated with a low-velocity-missile wound to the abdomen. All of the patients underwent an exploratory laparotomy at the time of admission and all received broad-spectrum antibiotics for a minimum of two days. None of the patients had an immediate laminectomy or an immediate debridement of the paraspinal area. In eight patients the gastrointestinal tract was not perforated, and none of them had evidence of infection. In four patients the stomach and small bowel were perforated by the bullet before it struck the vertebral column, and none of them had meningitis, paraspinal infection, or osteomyelitis. In contrast, meningitis, paraspinal infection, or osteomyelitis did develop in seven of eight patients in whom the bullet perforated the colon before it hit the vertebra. Perforation of the colon by a low-velocity missile before the missile fractured the thoracic or lumbar vertebra was associated with a high incidence of infection. The appropriate management may require early operative intervention. This is in contrast to the non-operative approach that has been advocated for low-velocity gunshot wounds to the spine. We agree that a non-operative approach is indicated for gunshot wounds of the abdomen that do not involve the colon.
我们回顾了20例患者的病例，这些患者的下胸椎或腰椎椎间盘间隙发生骨折或破坏，且与腹部低速导弹伤有关。所有患者在入院时均接受了剖腹探查术，并且均接受了至少两天的广谱抗生素治疗。没有患者立即进行椎板切除术或立即对椎旁区域进行清创术。8例患者的胃肠道未穿孔，且均无感染迹象。4例患者的胃和小肠在子弹撞击脊柱之前已被穿孔，且均未发生脑膜炎、椎旁感染或骨髓炎。相比之下，在8例子弹在撞击椎骨之前先穿透结肠的患者中，有7例发生了脑膜炎、椎旁感染或骨髓炎。低速导弹在骨折胸椎或腰椎之前先穿透结肠，与高感染发生率相关。适当的处理可能需要早期手术干预。这与一直提倡的对脊柱低速枪伤采用的非手术方法形成对比。我们同意，对于不涉及结肠的腹部枪伤，应采用非手术方法。
