Tachibana S, Okada K, Ohwada T, Yada K
No Shinkei Geka. 1984 Feb;12(2):183-8.
Although it is of great tragedy to lose motor and sensory function of the spinal cord by spinal cord injury, there is no effective measure for complete cord lesions. In the central gray of the spinal cord at the region of injury, hemorrhagic necrosis and edema advance causing secondary damage to the spinal cord in rather early stage after injury. It has not been proved whether to remove necrotic tissue in the central gray matter can be effective to prevent secondary damage of the spinal cord or not. Operative result of six patients with acute physiologically complete cervical spinal cord lesion who have been subjected to posterior longitudinal myelotomy and removal of hematoma and necrotic tissue of the central gray of the spinal cord were evaluated. All of them admitted to Kitasato University Hospital within 24 hours after injury. They were five males and one female aged twenty to fifty-three. All the patients showed complete block of contrast medium on myelography at the level of one to two segments above the neurologically estimated level or injury of the spine, indicating marked swelling of the spinal cord. Average duration from injury to operation was sixteen hours ranging from six to thirty nine. Posterior longitudinal myelotomy was performed by using microsurgical technique. Skull traction was performed by using Crutchfield tongs for six weeks in five and twelve weeks in one of the patients. On admission forty mg of dexamethasone was used as steroid therapy followed gradual reduction.(ABSTRACT TRUNCATED AT 250 WORDS)
尽管脊髓损伤导致脊髓运动和感觉功能丧失是巨大的悲剧，但对于完全性脊髓损伤尚无有效的治疗措施。在损伤区域的脊髓中央灰质，出血性坏死和水肿进展，在损伤后相当早期就会对脊髓造成继发性损害。切除中央灰质中的坏死组织是否能有效预防脊髓继发性损害尚未得到证实。对6例急性生理性完全性颈髓损伤患者进行了后纵行脊髓切开术，并清除脊髓中央灰质的血肿和坏死组织，对其手术结果进行了评估。所有患者均在受伤后24小时内入住北里大学医院。他们中有5名男性和1名女性，年龄在20岁至53岁之间。所有患者在脊髓造影时均显示在神经学估计水平或脊柱损伤上方1至2节段水平造影剂完全阻滞，表明脊髓明显肿胀。受伤至手术的平均时间为16小时，范围为6至39小时。采用显微外科技术进行后纵行脊髓切开术。5例患者使用Crutchfield钳进行颅骨牵引6周，1例患者进行12周。入院时使用40毫克地塞米松作为类固醇治疗，随后逐渐减量。（摘要截取自250字）
