颈前路减压术后早期一过性四肢瘫痪三例原因分析  

Causes of transient quadriplegia shortly after anterior cervical compression： a report of three cases

作　　者：张继东[1] 夏群[1] 吉宁[1] 刘艳成[1] 韩岳[1] 宁尚龙[1] 

机构地区：[1]天津医院脊柱外科,300211

出　　处：《中华创伤杂志》2012年第9期775-779,共5页Chinese Journal of Trauma

摘　　要：目的报道脊髓型颈椎病行颈椎前路减压固定术后患者麻醉清醒后检查四肢活动良好，其后短时内（术后4h内）突发一过性四肢截瘫的发病、处理、预后情况，分析其发生的可能原因。方法回顾性分析3例患者病历资料，其中男2例，女1例；年龄41～61岁。均在全身麻醉下接受前路颈椎体次全切除、钛网植骨和钛板内固定术。减压节段：1例C，椎体，1例C。椎体，1例C，椎体＋C。椎间盘。发生瘫痪时间为术后30min～4h。2例为完全性瘫痪，1例为不全瘫。全部患者发现截瘫后立即给予脱水、营养神经药物、大剂量甲基强的松龙冲击治疗，同时急症行颈椎MRI，均可见颈脊髓肿胀，未见明显血肿压迫脊髓。结果经早期药物治疗后2例患者截瘫在2h内完全缓解，未采用二次手术减压。1例患者药物治疗后24h仍恢复不全，遂进行颈椎后路椎管扩大成形术，术中发现颈脊髓内高压，经减压术后患者脊髓功能明显恢复，再次手术后1周脊髓功能基本恢复。结论颈椎病前路减压术后早期出现一过性四肢瘫痪除与脊髓缺血再灌注损伤有关外，还与术后颈脊髓肿胀及椎管减压空间有限有关。术后早期发现、早期治疗能够挽救脊髓功能，获得良好预后。Objective To study the onset, treatment, prognosis and possible causes of transient quadriplegia shortly after anterior cervical compression and fixation （within four hours postoperatively） in three patients with cervical spondylotic myelopathy who could function well for limbs after anesthesia a- wakening from the operation. Methods A retrospective study was carried out on medical data of three patients including two males and one females, at age of 41-61 years. Anterior cervical corpectomy, titani- um mesh bone fusion and titanic plate fixation were performed under general anesthesia. The decompres- sion segment was C5 in one patient, C6 in one and C5 plus C6/Tintervertebral disc in one respectively. Pa- ralysis occurred between 30 minutes and 4 hours postoperatively. Two patients were with complete paralys- is and one with incomplete. All the patients received dehydration, neurotrophic drugs and high-dose methylprednisolone therapy immediately after paralysis. Meanwhile, emergent cervical MRI was per- formed, which showed spinal cord swelling, without obvious spinal cord compression by hematoma. Results The paralysis was alleviated completely in two patients within two hours after early medication without additional surgical compression. The other one patient was recovered incompletely at 24 hours after medication and then underwent posterior cervical laminoplasty, when tremendous pressure was released from cervical spinal cord. But the spinal function had significant recovery after surgical compression and won complete recovery one week later. Conclusions Besides spinal cord ischemia-reperfusion injury, the transient paralysis after anterior cervical surgery may be associated with cervical spinal cord swelling and limited anterior decompression space. Early diagnosis and early intervention of paralysis may save the spinal cord function and attain a satisfactory prognosis.

关 键 词：颈椎病 外科手术 再灌注损伤 

分 类 号：R687.3[医药卫生—骨科学]