脊柱脊髓穿透伤合并金属异物存留处理  

Management of Penetrating Injuries to Spine and Spinal Cord with Retained Bullets

作　　者：沈岳[1] 王国强[2] 廖维宏[2] 

机构地区：[1]第三军医大学大坪医院创伤中心,重庆400042 [2]第三军医大学野战外科研究所,重庆400042

出　　处：《创伤外科杂志》1999年第3期141-143,共3页Journal of Traumatic Surgery

摘　　要：目的结合病例报道和文献复习交流脊柱脊髓穿透伤合并金属异物存留诊治的经验。方法回顾性分析我院近2年7例脊柱脊髓穿透伤的临床资料。结果4例完全性瘫痪的伤员不论何种处理方式均未有神经症状和体征的改善。在早期积极行异物取出术的4例伤员中1例出现伤口感染，1例忽略了腹腔内脏的合并伤。神经症状有所改善的3例均为不全瘫，其中2例为利器伤，1例为马尾神经损伤。结论急救处理时应首先稳定全身情况，注意合并伤；严格掌握清创和椎板切除的指征；存目的子弹不是引起感染的主要原因，也很少引起后期并发症，多无需预防性地行子弹取出术。Objective To share the experience in management of penetrating injuries to spine and spinal cord with retained bullets by case reports and literatures review. Methods The clinical data of seven wounded patients admitted to our hospital during last two years were retrospectively analysed. Results Four patients with complete paralysis obtained no improvement in neurological defects whatever the treatment were adopted .Among four cases undergone early active surgery of bullet removal, one developed wound infection and the other one had an ignored concurrent injury to the abdoment. Among three cases of incomplete paralysis, who achieved some neurological improvement ,two cases were wounded by edge tool and the other one was wounded at cauda equina. Con clusion The emergency care should consist of stabilizing the patients' medical conditions first before taking a careful comprehensive neurological examination with care of the concurrent injuries. The surgery of debridement and laminectomy should be controlled by strict indications. And the retained bullet fragments are rarely problematic and it isn' t the major source of the infection even when colonic injuries are associated. It is not necessary for prophylactic bullet removal.[

关 键 词：穿透伤 脊髓损伤 异物存留 脊柱损伤 

分 类 号：R651.2[医药卫生—外科学] R681.5[医药卫生—临床医学]