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

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

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C2,3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。

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 retro- spectively studied. Their mean age was 41.3 years （range, 39-42 years）. All 3 cases were undertaken open decompression, reduction and internal fixation. Paralysis level began to ascend at 2-5 days after injury, with 2 cases up to C2,3 and 1 case up to TT. Two patients suffered irritating pain over the paralysis level before on- set 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 Tl and long T2 signals shaped patchy and stripy distribution in the central area. One patient＇s MRI displayed that the spinal cord 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. Con- clusion 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 effective treatment are still unclear and need further investigated.