Miyazaki Y, Inaba K
No Shinkei Geka. 1976 Aug;4(8):799-803.
Stab wound of the spinal cord caused by accident occurred in the home life is rare absolutely. One case of stab wound of the cervical spinal cord caused by penetrated and retained glass fragment within the spinal canal was reported. A 30-year-old woman was hospitarized on August 16, 1971. with complaint of left hemiparesis, gait disturbance and sensory impairment on the right side. A glass door fell down on the patient's neck on April 14, 1971. and one glass fragment was removed from the patient's left neck by one of the patient's family and no immediate spinal cord symptom appeared and no physician was consulted at that time. One and a half month after the injury the patient rod a motor bicycle and pain and severe stiffness in the shoulder and neck, and headache. These subjective symptom disappeared by rest and same subjective symptom repeated in following five days. Three and a half months after the injury the patient found sensation loss in the right foot and gait distrubance appeared. After the sensory impairment extended to the cervical level which was accompanied by left hemiparesis. On examination, the patient was found to have merked weakness of left limbs, spastic gait and severe impairment of touchpain- and thermosensation below the fifth cervical level but deep sensation was preserved. All tendon reflexes showed marked exaggeration and pathological reflexes were proved. Roentgenograms of the cervical spine revealed a long triangular glass fragment which had been retained in the spinal canal between the first and second cervical vertebrae. The air myelogram suggested the glass fragment had transfixed the cervical spinal cord. Laminectomy was performed and the glass fragment which had a shape of a sharp pointed surgical knife was removed by gentle move in the opposite direction of invation. Following removal of the foreign body, the patient's left hemiparesis recovered to normal state at four months after the operation and right sensory impairment also improved. The cervical spinal cord may be injured in the following way: the right lateral spinothalamic tract may be injured by the skewer injury due to glass fragment but injury of the left same tract may be avoided because of oblique direction of penetration of the glass fragment in the spinal cord. On the other hand, the left pyramidal tract may be compressed by glass fragment and not injured, because left hemiparesis recovered very well postoperatively.
在家居生活中因意外导致的脊髓刺伤极为罕见。本文报告了一例因椎管内玻璃碎片穿透并残留而导致颈脊髓刺伤的病例。一名30岁女性于1971年8月16日入院，主诉左侧偏瘫、步态障碍及右侧感觉障碍。1971年4月14日一扇玻璃门倒在患者颈部，患者家属从其左颈部取出一块玻璃碎片，当时未立即出现脊髓症状，也未咨询医生。受伤后一个半月，患者骑摩托车，肩部和颈部疼痛、严重僵硬，并伴有头痛。这些主观症状经休息后消失，随后五天又反复出现相同主观症状。受伤三个半月后，患者发现右脚感觉丧失，出现步态障碍。感觉障碍扩展至颈部水平，并伴有左侧偏瘫。检查发现，患者左侧肢体明显无力，步态痉挛，颈5以下触觉、痛觉和温度觉严重受损，但深感觉保留。所有腱反射均明显亢进，并引出病理反射。颈椎X线片显示，第一和第二颈椎之间的椎管内残留一块长三角形玻璃碎片。空气脊髓造影提示玻璃碎片横贯颈脊髓。行椎板切除术，沿与刺入相反方向轻柔移动，取出形似锋利手术刀的玻璃碎片。取出异物后，患者左侧偏瘫在术后四个月恢复正常，右侧感觉障碍也有所改善。颈脊髓可能以下列方式受伤：玻璃碎片的穿刺伤可能损伤右侧脊髓丘脑侧束，但由于玻璃碎片在脊髓内的穿刺方向倾斜，左侧相同束可能未受损伤。另一方面，左侧锥体束可能被玻璃碎片压迫但未受损，因为术后左侧偏瘫恢复良好。
