胸腰椎骨折内固定后上升性截瘫:三例报告及相关文献复习

 目的探讨胸腰椎骨折内固定后上升性截瘫的临床特点与治疗。方法 回顾性分析 3家 医院分别诊治的 3例患者, 均为男性, 平均年龄 41.3岁(39~42岁)。骨折部位: 2例发生于 T₁₂椎体, 1例 发生于 L₁椎体。对 3例患者均行切开减压、复位内固定术。伤后 2~5天开始出现截瘫平面上升: 2例上 升至 C_{2, 3}水平, 1例上升至 T₇水平。发病前 2例患者出现截瘫平面上方的激惹性疼痛。术后 MR检查均 可见减压部位复位良好, 无明显脊髓压迫;早期表现为脊髓肿胀, 脊髓中央区斑片状或条索状长 T₁、长T₂ 信号。 1例于伤后 16天复查 MRI示脊髓明显变细, 脊髓中央区出现异常高信号。对 3例患者均给予 脱水、神经营养等药物治疗。结果 2例患者因呼吸肌麻痹分别于术后第 14天、32天死亡;1例为双下 肢截瘫, 术后 5年无恢复。结论 上升性截瘫为胸腰椎骨折后一种罕见而预后极差的并发症, MR检查 有助于评价手术疗效和脊髓变化的水平。胸腰椎骨折后上升性截瘫的确切机制和有效的治疗方法尚有待于进一步研究和探讨。

Ascending paralysis after thoracolumbar fracture: 3 cases reports and related literature review

Objective To investigate the clinical features and treatment of ascending paralysis after thoracolumbar fracture. Methods Three male patients with 2 fracture levels at T₁₂ and one at L₁ were retrospectively studied. Their mean age was 41.3 years (range, 39-42 years). All 3 cases were undertaken opendecompression, reduction and internal fixation. Paralysis level began to ascend at 2-5 days after injury, with2 cases up to C_2,3 and 1 case up to T₇. Two patients suffered irritating pain over the paralysis level before onset of ascending. Postoperative MRI images demonstrated well reduction and no compression of spinal cord. In the early phase after ascending, MRI obviously showed swelling in spinal cord and long T₁ and long T₂ signals shaped patchy and stripy distribution in the central area. One patient's MRI displayed that the spinalcord shrinked 16 days after trauma with abnormal high signal in the central area. Results Two cases died of respiratory muscle paralysis and 1 case suffered paraplegia with no recovery 5 years after surgery. Conclusion Ascending paralysis after thoracolumbar fracture is a rare complication with very poor prognosis. MRI is available for evaluating operational effects and affected level. The exact mechanism and effectivetreatment are still unclear and need further investigated.