Rarely,penetrating injuries to the spinal cord result from wooden objects,creating unique challenges to mitigate neurological injury and high rates of infection and foreign body reactions.We report a man who sustained...Rarely,penetrating injuries to the spinal cord result from wooden objects,creating unique challenges to mitigate neurological injury and high rates of infection and foreign body reactions.We report a man who sustained a penetrating cervical spinal cord injury from a sharpened stick.While initially tetraparetic,he rapidly recovered function.The risks of neurological deterioration during surgical removal made the patient reluctant to consent to surgery despite the impalement of the spinal cord.A repeat MRI on day 3 showed an extension of edema indicating progressive inflammation.On the 7~(th)day after injury,fever and paresthesias occurred with a large increase in serum inflammatory indicators,and the patient agreed to undergo surgical removal of the wooden object.We discuss the management nuances related to wood,the longitudinal evolution of MRI findings,infection risk,surgical risk mitigation and technique,an inflammatory marker profile,long-term recovery,and the surprisingly minimal neurological deficits associated with low-velocity midline spinal cord injuries.The patient had an excellent clinical outcome.The main lessons are that a wooden penetrating central nervous system injury has a high risk for infection,and that surgical removal from the spinal cord should be performed soon after injury and under direct visualization.展开更多
Thoracic spinal cord stab injuries are rare lesions. A 17-year-old boy was stabbed on his back by his classmate when he bent forward to pick up his cloth from the ground. On admission, he presented with: complete para...Thoracic spinal cord stab injuries are rare lesions. A 17-year-old boy was stabbed on his back by his classmate when he bent forward to pick up his cloth from the ground. On admission, he presented with: complete paraplegia with muscle strength of zero on all muscle groups, complete anesthesia from dermatome 10 and below, acute urinary retention, and a four-centimeter wound on the thoracolumbar region from which cerebrospinal fluid mixed with blood was oozing out. A high-dose methylprednisolone protocol was started (30 mg/kg in one hour and then 5.4 mg/kg over 23 hours) an indwelling urinary catheter placed and sterile dressing of the wound done. Antibiotics and analgesics were also administered. The computed tomography scanning revealed a spinal cord transection at T10-T11 level with incarceration of the broken knife blade. An emergency thoracic laminectomy was performed. Removal of the broken knife blade revealed complete spinal cord transection with a compressive hematoma within the spinal cord which was removed by smooth suction. The spinal dura was sutured and the wound closed in many layers. On day 14 after surgery, sensitivity was recovered with 3 on 5 muscle strength in both lower limbs except for both feet where motor function remained null. Urinary retention and fecal incontinence persisted. The patient was discharged from our service for a rehabilitation center. At 32-month follow-up, neurological examination was unchanged although patient noticed a slight improvement of sphincter disturbances.展开更多
背景:研究报道富血小板血浆可以激活和加速压力性损伤的愈合。目的:探讨富血小板血浆治疗脊髓损伤患者压力性损伤的效果。方法:选择2017年7月至2019年12月四川大学华西医院康复医学中心收治的脊髓损伤并发3期、4期压力性损伤患者40例,...背景:研究报道富血小板血浆可以激活和加速压力性损伤的愈合。目的:探讨富血小板血浆治疗脊髓损伤患者压力性损伤的效果。方法:选择2017年7月至2019年12月四川大学华西医院康复医学中心收治的脊髓损伤并发3期、4期压力性损伤患者40例,按照随机数字表法分2组,每组20例:对照组进行常规伤口护理及标准化的康复干预,观察组在常规伤口护理及标准化康复治疗的基础上进行自体源性富血小板血浆干预,每周1次。干预前及干预后2,4,6,8周,采用压疮愈合量表(pressure ulcer scale for healing,PUSH)动态评估伤口面积、伤口类型、渗液量,比较两组总分、各条目得分及临床综合疗效。研究获得四川大学华西医院生物医学伦理委员会批准[批准号:2019年审(622)号]。结果与结论:①观察组干预后各时间点的PUSH评分总分及伤口面积、伤口类型、渗液量评分低于干预前(P<0.01),对照组干预后6,8周的PUSH评分总分及伤口面积、伤口类型、渗液量评分低于干预前(P<0.01);②观察组干预后4,6,8周的PUSH评分总分与渗液量评分低于对照组,干预后6,8周的伤口类型评分低于对照组(P<0.01);③观察组治疗后的显效率高于对照组(100%,35%,P<0.001);④结果表明,富血小板血浆治疗脊髓损伤压力性损伤具有明显的疗效。展开更多
文摘Rarely,penetrating injuries to the spinal cord result from wooden objects,creating unique challenges to mitigate neurological injury and high rates of infection and foreign body reactions.We report a man who sustained a penetrating cervical spinal cord injury from a sharpened stick.While initially tetraparetic,he rapidly recovered function.The risks of neurological deterioration during surgical removal made the patient reluctant to consent to surgery despite the impalement of the spinal cord.A repeat MRI on day 3 showed an extension of edema indicating progressive inflammation.On the 7~(th)day after injury,fever and paresthesias occurred with a large increase in serum inflammatory indicators,and the patient agreed to undergo surgical removal of the wooden object.We discuss the management nuances related to wood,the longitudinal evolution of MRI findings,infection risk,surgical risk mitigation and technique,an inflammatory marker profile,long-term recovery,and the surprisingly minimal neurological deficits associated with low-velocity midline spinal cord injuries.The patient had an excellent clinical outcome.The main lessons are that a wooden penetrating central nervous system injury has a high risk for infection,and that surgical removal from the spinal cord should be performed soon after injury and under direct visualization.
文摘Thoracic spinal cord stab injuries are rare lesions. A 17-year-old boy was stabbed on his back by his classmate when he bent forward to pick up his cloth from the ground. On admission, he presented with: complete paraplegia with muscle strength of zero on all muscle groups, complete anesthesia from dermatome 10 and below, acute urinary retention, and a four-centimeter wound on the thoracolumbar region from which cerebrospinal fluid mixed with blood was oozing out. A high-dose methylprednisolone protocol was started (30 mg/kg in one hour and then 5.4 mg/kg over 23 hours) an indwelling urinary catheter placed and sterile dressing of the wound done. Antibiotics and analgesics were also administered. The computed tomography scanning revealed a spinal cord transection at T10-T11 level with incarceration of the broken knife blade. An emergency thoracic laminectomy was performed. Removal of the broken knife blade revealed complete spinal cord transection with a compressive hematoma within the spinal cord which was removed by smooth suction. The spinal dura was sutured and the wound closed in many layers. On day 14 after surgery, sensitivity was recovered with 3 on 5 muscle strength in both lower limbs except for both feet where motor function remained null. Urinary retention and fecal incontinence persisted. The patient was discharged from our service for a rehabilitation center. At 32-month follow-up, neurological examination was unchanged although patient noticed a slight improvement of sphincter disturbances.
文摘背景:研究报道富血小板血浆可以激活和加速压力性损伤的愈合。目的:探讨富血小板血浆治疗脊髓损伤患者压力性损伤的效果。方法:选择2017年7月至2019年12月四川大学华西医院康复医学中心收治的脊髓损伤并发3期、4期压力性损伤患者40例,按照随机数字表法分2组,每组20例:对照组进行常规伤口护理及标准化的康复干预,观察组在常规伤口护理及标准化康复治疗的基础上进行自体源性富血小板血浆干预,每周1次。干预前及干预后2,4,6,8周,采用压疮愈合量表(pressure ulcer scale for healing,PUSH)动态评估伤口面积、伤口类型、渗液量,比较两组总分、各条目得分及临床综合疗效。研究获得四川大学华西医院生物医学伦理委员会批准[批准号:2019年审(622)号]。结果与结论:①观察组干预后各时间点的PUSH评分总分及伤口面积、伤口类型、渗液量评分低于干预前(P<0.01),对照组干预后6,8周的PUSH评分总分及伤口面积、伤口类型、渗液量评分低于干预前(P<0.01);②观察组干预后4,6,8周的PUSH评分总分与渗液量评分低于对照组,干预后6,8周的伤口类型评分低于对照组(P<0.01);③观察组治疗后的显效率高于对照组(100%,35%,P<0.001);④结果表明,富血小板血浆治疗脊髓损伤压力性损伤具有明显的疗效。
