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題名 | Delayed Diagnosis of Traumatic Thoracic Disc Herniation with Neurologic Deficit in Multiple Injury Patient: Case Report=外傷性胸椎椎間盤突出併神經障礙的遲延診斷:病例報告 |
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作者姓名(中文) | 陳松雄; 高義然; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 33:3 民89.05-06 |
頁次 | 頁130-134 |
分類號 | 416.61 |
關鍵詞 | 脊椎損傷; 胸椎椎間盤突出; 神經障礙; Multiple injuries; Neurologic deficit; Spinal injury; Disc herniation; |
語文 | 英文(English) |
中文摘要 | 胸椎椎間盤突出引起的神經症狀並不多見且不易診斷,通常所見的臨床表現不很清晰,也因此會有遲延診斷。本篇主述一例多處外傷病患因為外傷性胸椎椎間盤突出造成厲害神經障礙的遲延診斷,病例是一個外傷性腦出血及多處骨折病患,有接受過兩次手術,但在住院後六星期才診斷出胸椎椎間盤突出而引起的下肢癱瘓。本例雖然接受脊椎減壓手術及復健,但是神經障礙都沒有明顯改善,歸納遲延當斷的可能原因有下列三個:(1)入院時沒有做好完整評估(2)腦受傷引起意識不清(3)太專注多處骨折而疏忽其它受傷部份。雖然病人沒有因為遲延診斷而造成死亡,但也引起明顯的後遺症,我們建議早期診斷及適當治療仍然是最好的方法。 |
英文摘要 | Symptomatic herniated thoracic discs are uncommon entities that are difficult to be diagnosed. They are always associated with a myriad of symptoms, which often delay diagnosis. We present such a case of delayed diagnosis of traumatic thoracic disc herniation with neurologic deficit. The patient was transferred to our ER due to traumatic ICH with multiple injuries. He was operated on twice, once for ICH, and the other time for a trochanteric fracture. " The post-operative condition was smooth, however, paraplegia with urine retention was found through the consciousness (Coma Scale E4V2M6) which improved at the sixth week after admission. " the MRI of thoracic spine- revealed a large disc herniation between T10 and T11, though the plain x-ray of the T-L spine did not demonstrate any spinal lesion except fracture of the right 11th rib. He received surgical decompression and physical therapy postoperatively, but paraplegia persisted. The causes of delayed diagnosis were: 1)failure to take a complete survey. 2) an altered level of consciousness due to head injury. 3) multiple injuries with an undocumented missed injury. None of the missed injuries resulted in death, however, missed injury caused serious disability. We would like to suggest that early diagnosis and adequate treatment are still needed to achieve the best outcome. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。