CAJ | 학술논문

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C5椎体,1例C6椎体,1例C5椎体+C6/7椎间盘.发生瘫痪时间为术后30 min～4 h.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24 h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.
목적 보도척수형경추병행경추전로감압고정술후환자마취청성후검사사지활동량호,기후단시내(술후4h내)돌발일과성사지절탄적발병、처리、예후정황,분석기발생적가능원인. 방법 회고성분석3례환자병력자료,기중남2례,녀1례；년령41 ～61세.균재전신마취하접수전로경추체차전절제、태망식골화태판내고정술.감압절단:1례C5추체,1례C6추체,1례C5추체+C6/7추간반.발생탄탄시간위술후30 min～4 h.2례위완전성탄탄,1례위불전탄.전부환자발현절탄후립즉급여탈수、영양신경약물、대제량갑기강적송룡충격치료,동시급증행경추MRI,균가견경척수종창,미견명현혈종압박척수. 결과 경조기약물치료후2례환자절탄재2h내완전완해,미채용이차수술감압.1례환자약물치료후24 h잉회복불전,수진행경추후로추관확대성형술,술중발현경척수내고압,경감압술후환자척수공능명현회복,재차수술후1주척수공능기본회복. 결론 경추병전로감압술후조기출현일과성사지탄탄제여척수결혈재관주손상유관외,환여술후경척수종창급추관감압공간유한유관.술후조기발현、조기치료능구만구척수공능,획득량호예후.
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 awakening 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,titanium mesh bone fusion and titanic plate fixation were performed under general anesthesia.The decompression segment was C5 in one patient,C6 in one and C5 plus C6/7intervertebral disc in one respectively.Paralysis occurred between 30 minutes and 4 hours postoperatively.Two patients were with complete paralysis and one with incomplete. All the patients received dehydration,neurotrophic drugs and high-dose methylprednisolone therapy immediately after paralysis. Meanwhile,emergent cervical MRI was performed,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 medicationand 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.