T12 Compression Fracture Complicated with Delayed Spinal Epidural Hematoma: A Case Report

第十二節胸椎壓迫性骨折合併遲發性脊椎硬膜外血腫：病例報告

烏佳瑋(Chia-Wei Wu) ； 曾清祥(Ching-Shiang Tseng) ； 謝霖芬(Lin-Fen Hsieh)

《台灣復健醫學雜誌》 39卷4期 (2011/12) Pp. 227-232

https://doi.org/10.6315/2011.39(4)04

摘要

脊椎壓迫性骨折後合併遲發性脊椎硬腦膜外血腫雖屬罕見，但卻是造成脊髓損傷的重要原因之一。本篇提出一外傷性第十二節胸椎壓迫性骨折合併遲發性脊椎硬腦膜外血腫，因而導致脊髓壓迫及馬尾症候群的個案。一位74歲男性因外傷性第十二節胸椎壓迫性骨折發生嚴重下背痛，一開始並無神經學的缺損；但在後續的兩個半月中逐漸出現雙下肢無力、感覺缺損，及排尿功能異常。磁振造影檢查顯示第十二節胸椎至第五節腰椎之硬腦膜外血腫。患者接受減壓手術清除血塊，並於術後接受復健治療，神經功能逐漸恢復。追蹤至受傷後一年半時，患者可持四腳拐獨立行走。提出本報告的目的，旨在提醒臨床醫師在處理外傷性脊椎壓迫性骨折時，需注意後續的神經學變化及其他併發症，早期診斷及治療，以確保患者有較好的預後及避免醫療糾紛的發生。

關鍵字

脊椎骨折（spinal fracture） ； 脊椎硬膜外血腫（spinal epidural hematoma） ； 壓迫性骨折（compressionfracture） ； 脊髓損傷（spinal cord injury） ； 馬尾症候群（cauda equina syndrome）

並列摘要

Delayed spinal epidural hematoma (SEH) after a spinal compression fracture is a very rare but important cause of symptomatic spinal cord compression. We report a patient with spinal cord compression and cauda equina syndrome due to delayed SEH after a traumatic T12 compression fracture. A 74-year-old male patient had severe back pain without neurologic deficits after a traumatic T12 compression fracture. He developed progressive bilateral lower extremity weakness, sensory loss, and sphincter dysfunction 2.5 months after the injury. Magnetic resonance imaging of the spine revealed a huge spinal epidural hematoma at the level of T12 to L5. He then received decompressive surgery half a month later. He also received rehabilitation training after surgery. His neurologic deficits improved gradually, and he could walk independently with a quadricane 1.5 years after the injury. Education about the possibility of complications and close follow-up of patients with spinal compression fracture enhances the chance of early diagnosis and treatment, which ensure a good clinical outcome and thus avoids medico-legal issues.

並列關鍵字

spinal fracture ； spinal epidural hematoma ； compression fracture ； spinal cord injury ； cauda equina syndrome