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臺灣急診醫學會醫誌

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篇名 An Upward Migrating Intraspinal Bullet: A Case Report
卷期 13:1
並列篇名 脊椎內向上移動的子彈:病例報告
作者 王仲毅陳正能
頁次 38-42
關鍵字 脊椎的槍傷cauda equina syndromemigration of bulletspinegunshot injury馬尾症候群子彈移動TSCI
出刊日期 201103

中文摘要

脊椎的槍傷在臺灣是少見的傷害,不論子彈的直接打擊或震盪作用都對脊髓和脊柱造成傷害。在急診室中,由病史、理學檢查和適當的影像學檢查作詳細的評估是有效治療的關鍵,治療的原則包括脊椎穩定、積極的復健、和神經功能的保存。我們描述一位三十歲的女性,她遭受由低速槍枝造成的脊椎槍傷,且子彈由在腰穿過脊膜和在蜘蛛網膜下隨意地移動,患者在受傷後立即發生馬尾症候群,包括在下肢乏力,感覺缺損和膀耽缺乏功能。腹部電腦斷層檢查顯示子彈最入腰椎第五節,緊急于術中發現子彈在脊膜內向上移動,于術後兩個月患者的症狀完全緩解。

英文摘要

A gunshot injury of the spine is an unusual injury in Taiwan. Both the direct path of the bullet and its concussive effects can cause injury to the spinal cord and spinal column. In the emergency department (ED), a thorough evaluation with a history, physical examination and appropriate radiographic studies are the keys to effective treatment. Principles of treatment include spinal stability, aggressive rehabilitation, prevention of infection and preservation of neurologic function. We describe a 20-year-old woman with a gunshot injury to the spine caused by a low-velocity weapon. The bullet penetrated the thecal sac via the left flank region and wandered freely in the subarachnoid space. The patient developed cauda equine syndrome including weakness of the left lower leg,
sensory deficit and loss of bladder function immediately after the injury. A two-dimensional abdominal computed tomographic scan showed a bullet in the spinal canal ( L5 level). Intradural upward migration of the bullet was noted intraoperatively. The patient had complete relief of symptoms by 2 months following surgery.

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