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| 地震后四肢瘫伤员在野外环境下的急诊救治 |
| 叶晓健1,袁红斌2,何海龙1,许国华1,卢旭华1,徐海涛2,蒋京京2,丰建明1,王进华1*,刘虎2,羊海琴2 |
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| (1.第二军医大学长征医院骨科,上海 200003;2.第二军医大学长征医院麻醉科,上海 200003) |
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| 摘要: |
| 目的：探讨地震中四肢瘫伤员在野战环境下的急诊救治方案。方法：第二军医大学长征医院抗震救灾医疗救护所四肢瘫伤员1例,男,57岁,在四川汶川大地震中被重物砸伤6 d,经体检诊断为颈椎脊髓损伤伴不完全瘫。急诊行气管插管下全身麻醉颈椎后路全椎板切除减压术。结果：患者术后双下肢肌力从Ⅰ级恢复至Ⅳ级,上肢肌力从Ⅲ级恢复至Ⅴ级,感觉丧失平面从乳头平面下降至正常。结论：地震后四肢瘫伤员的急诊外科救治可以及时解除脊髓的压迫,大大改善患者的预后,在条件不完备的野战条件下,可以采用颈椎后路全椎板减压手术来达到颈脊髓减压的目的。手术成功的关键在于准确的诊断和精细的操作。 |
| 关键词: 地震 脊髓损伤 急诊处理 |
| DOI：10.3724/SP.J.1008.2008.00581 |
| 投稿时间：2008-06-01修订日期：2008-06-01 |
| 基金项目: |
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| Urgent management of quadriplegia following Sichuan earthquake under field condition |
| YE Xiao-jian1,YUAN Hong-bin2,HE Hai-long1,XU Guo-hua1,LU Xu-hua1,XU Hai-tao2,JIANG Jing-jing2,FENG Jian-ming1,WANG Jin-hua1* ,LIU Hu2,YANG Hai-qin2 |
| (1.Department of Orthopedics,Changzheng Hospital,Second Military Medical University,Shanghai 200003,China;2.Department of Anesthesiology,Changzheng Hospital,Second Military Medical University,Shanghai 200003) |
| Abstract: |
| Objective：To explore the urgent management strategy for quadriplegia following China Wenchuan earthquake under filed condition. Methods: The 57-year-old male patient was sent to the earthquake relief team of Changzheng Hospital,Second Military Medical University. He was hit by heavy object during the Sichuan earthquake 6 days ago. Physical examination revealed cervical spinal cord injury accompanied by incomplete paralysis. The patient underwent cervical 3-7 laminectomy under general anesthesia. Results: After surgery,the muscle strength of lower limbs recovered to grade four from grade one; the muscle strength of upper limbs recovered to grade five from grade three. Sensory loss was found below the nipple level and totally recovered after operation. Conclusion: Early surgery for quadriplegia following earthquake trauma can timely relieve compression to the spinal cord and therefore improve prognosis of patients. Under field condition where facilities are not readily available,decompression of spinal cord can be achieved by laminectomy via posterior approach. The key to successful operation is correct diagnosis and skillful manipulation. |
| Key words: earthquakes spinal cord injuries emergency treatment |
