以弛缓性瘫痪为特点的高位置脊髓损伤临床特征探讨

目的分析以弛缓性瘫痪为特点的高位置脊髓损伤发生原因。方法在1014例创伤性脊髓损伤患者中对以弛缓性瘫痪为特点的高位置脊髓损伤（骨折水平在T₁₀或以上）患者进行分析。结果6例患者被确认为以弛缓性瘫痪为特点的高位置脊髓损伤，其中男性5例，女性1例，平均年龄（42±12）岁。脊髓损伤水平分布在C₇～T₈水平，脊柱骨折水平在T₃～T₁₀。参考骨折水平，4例脊髓损伤水平上升超过3个脊髓节段，其中3例脊髓损伤水平上升出现在外科手术后；1例无明显诱因，伤后48 h出现神经损伤平面进行性上升至C₇水平，伴随胸部严重疼痛。伤后6个月MRI检查，5例患者显示广泛胸段脊髓萎缩变细。结论以弛缓性瘫痪为特点的高位置脊髓损伤非常罕见。其重要特点是病理上存在广泛胸段脊髓萎缩变细。发生原因尚不清楚。

High Spinal Cord Injury Characterized by Flaccid Paralysis

ObjectiveTo investigate the characteristics of patients with flaccid paralysis after high spinal cord injury. Methods1014 cases with traumatic spinal cord injury were investigated. The patients with flaccid paralysis after high spinal cord injury (spinal fractures above the level of T₁₀) were analyzed. Results6 patients were ananlyzed, including 5 males and 1 female, mean of age was (42±12). The neurological injury involved C₇ to T₈, and the fractures involved T₃ to T₁₀. 3 cases had the neurological deterioration upward at least 3 spinal segments after operation compared with the fractures. One case accomplicated with severe pain in the chest had the subacute progressive ascending myelopathy up to C₇ level. MRI showed extensive atrophy of thoracic spinal cord 6 months later in 5 cases. ConclusionThe incidence of flaccid paralysis after high spinal cord injury was rare. It presents the extensive thoracic spinal cord atrophy, and the causes and mechanisms are not clear.