主垡剑笾苤查!!!!生!旦笙!!鲞筮!塑￡!!!』墅!!里!，!!P!!坐!!!!!!!：y!!垫：塑!：里颈前路减压术后早期一过性四肢瘫痪三例原因分析张继东夏群吉宁刘艳成韩岳宁尚龙【摘要】目的报道脊髓型颈椎病行颈椎前路减压固定术后患者麻醉清醒后检查四肢活动良好，其后短时内(术后4h内)突发一过性四肢截瘫的发病、处理、预后情况，分析其发生的可能原因。方法回顾性分析3例患者病历资料，其中男2例，女1例；年龄41～6l岁。均在全身麻醉下接受前路颈椎体次全切除、钛网植骨和钛板内固定术。减压节段：1例C，椎体，l例C。椎体，1例c，椎体+c。椎间盘。发生瘫痪时间为术后30rain一4h。2例为完全性瘫痪，1例为不全瘫。全部患者发现截瘫后立即给予脱水、营养神经药物、大剂量甲基强的松龙冲击治疗，同时急症行颈椎MRI，均可见颈脊髓肿胀，未见明显血肿压迫脊髓。结果经早期药物治疗后2例患者截瘫在2h内完全缓解，未采用二次手术减压。1例患者药物治疗后24h仍恢复不全，遂进行颈椎后路椎管扩大成形术，术中发现颈脊髓内高压，经减压术后患者脊髓功能明显恢复，再次手术后l周脊髓功能基本恢复。结论颈椎病前路减压术后早期出现一过性四肢瘫痪除与脊髓缺血再灌注损伤有关外，还与术后颈脊髓肿胀及椎管减压空间有限有关。术后早期发现、早期治疗能够挽救脊髓功能，获得良好预后。【关键词】颈椎病；外科手术；再灌注损伤Causesoftransientquadriplegiashortlyafteranteriorcervicalcompression：areportofthreeca-sesZHANGJi—d。凡g，X1AQun，JlNing，L1UYan—cheng，HANYue，NINGShang—long．DepartmentofSpinalSurgery，TianjinHospital，Tianjin300211，ChinaCorrespondingauthor：XIAQun，Email：xiaqun6@163．corn【Abstract】ObjectiveTostudytheonset，treatment，prognosisandpossiblecausesoftransientquadriplegiashortlyafteranteriorcervicalcompressionandfixation(withinfourhourspostoperatively)inthreepatientswithcervlcalspondylotiemyelopathywhocouldfunetionwellforlimbsafteranesthesiaa—wakeningfromtheoperation．MethodsAretrospectivestudywascarriedoutonmedicaldataofthreepatientsincludingtwomalesandonefemales，atageof41—61years．Anteriorcervicalcorpectomy，titani—ummeshbonefusionandtitanicplatefixationwereperformedundergeneralanesthesia．Thedecompres—sionsegmentwasC5inonepatient，C6inoneandC5plusC6，7intervertebraldiscinonerespectively．Pa—ralysisoccurredbetween30minutesand4hourspostoperatively．Twopatientswerewithcompleteparalys—isandonewithincomplete．Allthepatientsreceiveddehydration，neurotrophicdrugsandhigh—dosemethylprednis010netherapyimmediatelyafterparalysis．Meanwhile，emergentcervicalMRlwasper—formed，whichshowedspinalcordswelling，withoutobviousspinalcordcompressionbyhematoma．ResultsTheparalysiswasalleviatedcompletelyintwopatientswithintwohoursafterearlymedicationwithoutadditionalsurgicalcompression．Theotheronepatientwasrecoveredincompletelyat24hoursaftermedication"andthenunderwentposteriorcervicallaminoplasty，whentremendouspressurewasreleasedfromcervicalspinalcord．Butthespinalfunctionhadsignificantrecoveryaftersurgicalcompressionandwoncompleterecoveryoneweeklater．ConclusionsBesidesspinalcordischemia—reperfusioninjury，thetransientparalysisafteranteriorCervicalsurgerynlaybeassociatedwithcervicalspinalcordswellingD01：10．3760／cma．jissn．1001—80502012．09．003作者单位：300211天津医院脊柱外科(张继东，电话：13652090295，Email：bird0496@sina．corn)通信作者：夏群，电话：13001322663，Email：xiaqun6@163．corn·颈椎损伤·万方数据生堡剑鱼盘查!!!!生!旦筮垫鲞筮!塑鱼坠!』!望!坐!：!!P!!坐!竺；!!!：!些：型：型!：兰andlimitedanteriordecompressionspace．Earlydiagnosisandearlyinterventionofparalysismaysaveth...
