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Three cases of iatrogenic spinal fluid injury were reported by Li Chunzhi. After timely detection and effective treatment, the spinal cord function was satisfactory. Conclusion The iatrogenic hydraulic shock damage hormone hyperbaric oxygen can effectively block secondary injury and promote the recovery of spinal cord function.
Spinal surgery or spinal canal angiography can cause unpredictable spinal cord injury. Three cases of spinal cord hemorrhagic fluid injury were reported in this paper, and its mechanism, prevention and treatment were reported. To investigate this 1 clinical data 1.1 general data in this group of 3 cases of male cervical spondylotic anterior decompression and bone grafting in 2 cases; lower thoracic spinal canal tumors in 1 case of spinal canal angiography.
1.2 Case introduction 1.2.1 The spinal cord-type collar disease 1 disease was treated with anterior decompression, 2 cases were treated with cervical plexus anesthesia in 2 cases, the patient was always awake, can talk to the limbs, cooperate with active activity, and the toe flexed and flexed 1 case for the neck 5 Subtotal corpectomy, anterior decompression and autogenous iliac bone grafting; 1 case of autologous iliac bone grafting in 5 cases of cervical resection; 2 cases of toe can be actively stretched and decompressed before implantation of bone graft . The cervical vertebrae have oozing blood in the nucleus. After the suction, the appropriate humerus block is embedded in the bone groove. During the hammering and embedding process, the front edge of the bone graft is not flushed with the bone graft. The vertebral body surface violent twitching, the patient complained that the lower limb numbness was lost, and the toe active extension and flexion disappeared. Then observe that the bone does not fall into the trough and contact the cervical spinal cord or the dural sac. There is blood and blood clots in the tank, and the blood is exhausted. Repeated rinsing with iced saline without re-replanting the bone after fresh bleeding. Postoperatively, it was a high paraplegia and was treated with a neurodegenerative drug called a dehydrating agent. On the third day after operation, the muscle strength of the lower extremity began to recover gradually. After 3 weeks, the urinary catheter was self-extracted. The follow-up observation was performed until the preoperative level of the lower extremity muscle strength was restored. The sensation was faster than that before surgery. Improvement; the other 1 patient's lower extremity sensory muscle strength began to recover 1 week after surgery, plus hyperbaric oxygen treatment for 2 weeks, to the postoperative 3 months to restore preoperative level received date 200082; revised date 2 magic 0247 tube angiography, angiography There is only the left groin and the inner thigh radiating pain. At night, the waist is selected as the puncture point, and the lumbar wear is successful. The clear transparent drip rate is about 3040 drops, and the cerebrospinal fluid is taken to 9. When the patient complains that the original left lower extremity radiates pain, it can be patient, and a total of about 15 is released. The subarachnoid space of the scorpion was injected into the Ou Nai Paike. When the injection was 8, the patient complained that the radiation pain in the left lower extremity suddenly increased, and the screaming was unbearable. The operator feared that the patient's position changed, and the pressure quick bolus totaled 14 out. More than that, immediately take the supine position to see the obstruction of the milkmaker ascending to the chest plane, and then take the lower position to shoot the thoracic segment. The slanting position of the fox is now a cup-like obstruction. At this time, the patient complains that the limbs are unconscious, and the lower limbs are soft. After 3 hours, the tumor was completely removed under emergency operation under local anesthesia. The pathologically confirmed diagnosis and treatment were performed by dehydrating hormone neurotrophic drugs and vasodilators. After 14 hours, the lower limbs began to warm up. On the 2nd day, the toes began to recover. The muscle strength of both lower extremities gradually recovered. On the 4th day, the urination was self-resolved. After 3 weeks of hyperbaric oxygen, the left lower extremity only left the left hip flexor muscle level 1 level. The rest of the heart was level and the gait was stable. Three cases of surgery or angiography to the spinal cord for hydraulic impact injury for bifurcation. We speculate that the mechanism of injury and good prognosis may be related to the following serotonin. The general situation is that the intraluminal compensation gap is relatively limited; When the evening pressure is evenly distributed, when the contrast agent is injected, the short-term hammering force can be injected into the blood body or the transient high-pressure rapid injection of the contrast agent liquid can generate a huge impact squeezing force on the spinal cord. The spinal cord under the above external force will undergo microcirculation, especially the decompression of the cervical spinal cord compression area; the intramedullary nerve sputum 1. The woven fabric can also directly suffer from oppressive damage; When there is swelling and pain under the membrane, the circulation of cerebrospinal fluid is not smooth. During the process of taking cerebrospinal fluid and injecting contrast agent, the phase velocity is not synchronized. If it is not cold, the pressure difference between the two sides of the epidural dura mater 1 is caused by the pressure difference; when the film is taken, the head and the lower part of the tumor are repeatedly changed, and the tumor body is displaced up and down, which avoids the abrasion of the spinal cord. Straight section causes the incarcerated injury of the spinal cord. The injury response secondary to the spinal cord injury is continuous. The treatment of cutting is the delay or the secondary injury. Secondary injury mainly includes edema inflammation, ischemia reperfusion and abnormal peroxidation groups, which have evolved for several hours, are reversible and can be controlled 123! In addition to the direct compression of blood vessels, spinal cord ischemia is also associated with vasospasm caused by the release of vasoactive substances. After spinal cord injury, due to increased free radical production, inhibition of prostacyclin can cause thromboxane into 2 synthesis and platelet aggregation, which is strong, causing microvascular occlusion and spasm, indirectly causing spinal cord ischemia. 56. From the occurrence of the spinal cord hydraulic impact injury to the final basic recovery, it involves the mechanism of ischemia, reperfusion and free radical production of spinal cord compression edema. Fortunately, after the discovery, it is found that the extraction and sputum are effective measures such as relieving pressure to remove the tumor. Cerebrospinal fluid circulating spinal cord blood supply and subsequent hormone vasodilator hyperbaric oxygen treatment, 3 cases in this group have avoided catastrophic consequences. The three cases of human spinal fluid injury occurred in this group are iatrogenic accidents, although only 3 For example, it should be alert and take corresponding prevention and control measures. 1. The anterior decompression of the neck should be used to completely stop the bleeding. In addition, the shallow groove should be pre-made on both sides of the bone graft to prepare the blood flow. 2 When spinal canal angiography is used to take cerebrospinal fluid angiography, it should be combined with medical history and symptom characteristics. The patient's complaints should be highly valued during the operation. The cerebrospinal fluid should be taken slowly, and the strength of the contrast agent should be light. Slow, when the patient complains that the symptoms are unbearable, the operation should be decisively discontinued, and other non-invasive tests such as 刖1 should be used for nerve injury or paraplegia. Early effective treatment should be performed to confirm that no other pressure-producing substances exist, early hormone dehydrating nerves Nutritional drugs, if necessary, high-oxygen treatment for 23 weeks 2 If there is a place in the spinal canal, such as a tumor, without losing the opportunity, immediate surgery, decompression, removal of the tumor, Qiu speed recovery of cerebrospinal fluid, postoperative administration of hormone dehydrating agents and neurotrophic drugs, etc. According to the recovery of limb function, re-expanding vascular hypertension, etc. during the treatment period, the heart functioning and snoring function will help to recover 6 Jia Lianshun. Research, status and progress of drug treatment for spinal cord injury. Chinese spine ridge
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