Department of Rehabilitation Medicine, Wuhan University of Science and Technology Affiliated Wuhan Resources & Wisco General Hospital, Wuhan, China.
Medical School, Wuhan University of Science and Technology, Wuhan, China.
Medicine (Baltimore). 2024 Jul 26;103(30):e38852. doi: 10.1097/MD.0000000000038852.
Spinal cord ischemia injury is a serious complication after intra-aortic surgery, with a low incidence but high disability rate. However, patients often do not receive comprehensive treatment in the early stages of the disease. Therefore, active neurological intervention is needed to protect and prevent spinal cord ischemia during and after surgery. In this paper, rehabilitation program and imaging data of 2 cases with spinal cord ischemic injury are presented and discussed regarding causes, prevention and acute treatment with this disease, which could be referred by clinicians.
Case report 1: A 69-year-old male patient underwent aortic arch aneurysm and thoracic endovascular aortic repair (coated stent) was performed under general anesthesia. Complete paralysis of both lower limbs, constipation, and urinary retention occurred after surgery and was subsequently referred to our rehabilitation department. Case report 2: A man aged 41 years experienced sudden chest pain with no dizziness or headache. Weakness of both lower limbs gradually appeared over 30 minutes with subsequent loss of consciousness. He was diagnosed with aortic dissection and underwent aortic stent implantation. Inpatient rehabilitation began systematically 3 months after discharge.
The 2 patients were diagnosed with paraplegia and spinal cord ischemic injury.
The patients received strength and transfer training, sensory input, health mission, and activities of daily living.
Patient 1 returned home without assistive devices and patient 2 returned home with wheelchair.
Perioperative spinal cord protection is directly related to postoperative quality of life. Once the symptoms of spinal cord ischemic injury occur, cerebrospinal fluid drainage should be performed as soon as possible to increase mean arterial pressure. At the same time, methylprednisolone, ganglioside, anticoagulation, vasodilator drugs, and symptomatic supportive treatments are required. Intercostal artery and subclavian artery are reconstructed if necessary. Symptom stability flags referral to commence rehabilitation. Repetitive functional training is necessary to help patients return to the family and society as soon as possible.
脊髓缺血性损伤是主动脉内手术后的一种严重并发症，发病率低但残疾率高。然而，患者在疾病早期往往得不到全面治疗。因此，需要在手术期间和之后积极进行神经干预，以保护和预防脊髓缺血。本文介绍并讨论了 2 例脊髓缺血性损伤患者的康复计划和影像学资料，包括发病原因、预防和急性治疗，以供临床医生参考。
病例报告 1：一位 69 岁男性患者在全身麻醉下接受主动脉弓动脉瘤和胸主动脉腔内修复（覆膜支架）。手术后出现双下肢完全瘫痪、便秘和尿潴留，随后被转至我们的康复科。
病例报告 2：一位 41 岁男性突发胸痛，无头晕或头痛。30 分钟后逐渐出现双下肢无力，随后意识丧失。诊断为主动脉夹层，行主动脉支架植入术。出院后 3 个月开始系统的住院康复。
2 例患者均诊断为截瘫和脊髓缺血性损伤。
患者接受了力量和转移训练、感觉输入、健康宣教和日常生活活动。
患者 1 无需辅助设备即可回家，患者 2 则需要坐轮椅回家。
围手术期脊髓保护与术后生活质量直接相关。一旦出现脊髓缺血性损伤症状，应尽快进行脑脊液引流以增加平均动脉压。同时，需要使用甲基强的松龙、神经节苷脂、抗凝、血管扩张药物以及对症支持治疗。如有必要，还需要重建肋间动脉和锁骨下动脉。症状稳定后，建议开始康复治疗。需要进行重复的功能训练，帮助患者尽快回归家庭和社会。
