Isiklar Z U, Lindsey R W
Department of Orthopaedic Surgery, Baskent University Hospital, Ankara, Turkey.
Injury. 1998;29 Suppl 1:SA7-12.
In the USA, low velocity gunshot injuries (GSI) account for 13% of all urban spinal injuries, and they have become the second leading cause of all spinal cord injuries. The initial clinical evaluation should assess vascular, visceral, and/or neurological injury. Early imaging studies are required with computerized tomography in addition to plain radiographs to assess accurately the location and extent of the bone injury. The role of steroids is unclear, and if given, should be administered to GSI patients with complete or partial neurological deficit who present within eight hours of injury. The indications for prophylactic antibiotics have not been well established and although recommended, these are deemed essential only in patients with associated visceral perforation. Early surgical exploration is most appropriate to address associated vascular or visceral injury, while spinal decompression does not appear to influence neurological recovery. The majority of GSI spine fractures are stable; instability is usually due to ill-advised decompression of cervical spine GSI. Retained bullet fragments are rarely problematic; lead toxicity can occur due to missile contact with the synovial fluid, disc space, or contact with a pseudocyst.
在美国，低速枪伤（GSI）占所有城市脊柱损伤的13%，已成为所有脊髓损伤的第二大主要原因。初始临床评估应评估血管、内脏和/或神经损伤。除了普通X线片外，还需要早期进行计算机断层扫描成像研究，以准确评估骨损伤的位置和程度。类固醇的作用尚不清楚，如果使用，应给予伤后8小时内出现完全或部分神经功能缺损的GSI患者。预防性抗生素的适应证尚未明确确立，尽管有推荐，但仅在伴有内脏穿孔的患者中被认为是必要的。早期手术探查最适合处理相关的血管或内脏损伤，而脊柱减压似乎不会影响神经功能恢复。大多数GSI脊柱骨折是稳定的；不稳定通常是由于对颈椎GSI进行了不当减压。残留的子弹碎片很少有问题；由于子弹与滑液、椎间盘间隙接触或与假囊肿接触，可能会发生铅中毒。
