椎板切除联合椎管内压力监测治疗颈髓损伤两例并文献复习

Two cases of cervical spinal cord injury treated by laminectomy combined with intraspinal pressure monitoring and literature review

目的 总结在急性颈髓损伤患者行减压固定手术中、术后应用椎管内压力(ISP)监测的临床经验。方法 回顾性分析2019年11月—2019年12月广州医科大学附属第六医院神经外科收治的2例急性颈髓损伤患者,均行颈椎椎板减压,硬脊膜减张缝合,钉棒系统固定。硬脊膜切开前,先穿刺置入压力探头测压。硬脊膜切开后,穿刺并将压力探头置入髓外硬膜下脊髓肿胀部位测压。减张缝合硬脊膜,留置压力探头,切口旁皮肤穿出并固定,术后连续监测。结合相关文献进行复习。结果 硬脊膜切开前,压力探头测得压力值分别是13、15 mmHg;切开硬脊膜后,脊髓肿胀部位压力探头测压值分别是8、9 mmHg;术后连续监测,压力波动在13~22 mmHg之间。术后腰穿测压力为150 mmH_(2)O,同时脊髓压力监测数值为26 mmHg(300 mmH_(2)O)。结论 急性颈髓损伤患者硬脊膜切开可有效减轻ISP压力,术后连续监测ISP,可以监测脊髓灌注压,指导透水药物的应用,同时受伤颈髓局部压力高于椎管内整体压力。

Objective To summarize the clinical experience of intraspinal pressure monitoring in patients with acute cervical spinal cord injury during and after decompression and fixation surgery. Methods 2 patients with acute cervical spinal cord injury admitted to the Department of Neurosurgery, the Sixth Hospital Affiliated to Guangzhou Medical University from November 2019 to December 2019 were analyzed retrospectively. They were treated with cervical laminar decompression, dural decompression suture, and nail-stick system fixation. Before incising the dura, a pressure probe was inserted into the extramedullary subdural for manometry. After incision of the dura mater, the swollen part of the spinal cord was selected, and a pressure probe was inserted to measure the pressure. Before decompression and suture of the dura mater, a pressure probe was placed under the dura mater for continuous monitoring postoperatively. Results Before incision of the dura mater, a pressure probe was first inserted to measure the pressure, with pressures of 13 and 15 mmHg respectively. After incision of the dura mater, the swollen part of the spinal cord was selected, and a pressure probe was inserted to measure the pressure. The measured pressures were 8 and 9 mmHg, respectively. Continuous postoperative monitoring showed pressure fluctuations between 13-22 mmHg. Postoperative lumbar puncture measurement pressure was 150 mmH_(2)O, while spinal cord pressure monitoring value was 26 mmHg(300 mmH_(2)O). Conclusions In patients with acute cervical spinal cord injury, the pressure before dural incision is significantly higher than that after incision, confirming the effectiveness of decompression surgery.Continuous monitoring of ISP after operation can monitor spinal cord perfusion pressure and guide the application of dehydration drugs. Postoperative lumbar puncture confirmed that the local pressure of the injured cervical cord was significantly higher than the overall pressure in the spinal canal.