Paraplegia Due to Spinal Epidural Hematoma after ＂Gua sha＂: A case Report

刮痧後之脊椎硬膜外血腫導致之偏癱：病例報告

楊凱超(Kai-Chao Yang) ； 謝政達(Cheng-Ta Hsieh) ； 王永成(Yung-Cheng Wang) ； 張志儒(Chin-Ju Chang)

《輔仁醫學期刊》 13卷2期 (2015/06) Pp. 91-97

https://doi.org/10.3966/181020932015061302004

摘要

背景：脊椎硬膜外血腫是罕見的病例，並且可能導致四肢癱瘓／偏癱。及時清除血腫廣泛的被認為是第一線治療有症狀的脊椎硬膜外血腫。刮痧是傳統的中醫治療，藉由清除其自受傷部位釋放有害因子，並且促進血液循環而加速痊癒。方法：病例報告與文獻回顧。結果：一位42歲女性在刮痧後導致偏癱。在頸椎第四節至胸椎第二三節處有脊椎硬膜外血腫，並伴有脊索壓迫。在接受緊急頸椎第四節至胸椎第二節椎板切除與血腫清除術後，病患復原良好，於術後第11天順利出院。結論：刮痧在頸胸椎與胸腰椎處施行時必須小心謹慎。突然地改變靜脈壓力可能導致硬膜外靜脈叢破裂，甚至於產生硬膜外血腫。緊急手術減壓普遍被接受對於有症狀的脊椎硬膜外血腫。藉由迅速而充分的減壓，患者即便導致偏癱也能有良好的預後。

關鍵字

脊椎硬膜外血腫 ； 刮痧 ； 偏癱

並列摘要

Background: Spinal epidural hematoma (SEH) is a rare pathology and could develop into quadriparesis/paraparesis. Prompt evacuation of the hematoma is generally regarded as first treatment for symptomatic SEH. Gua sha is a traditional Chinese medical treatment that releases unhealthy elements from injured areas and stimulates blood flow and healing. Methods: Case report and literature review. Findings: A 42-year-old female suffered from paraplegia after Gua sha. She had spinal epidural hematoma from the C4 level to the T2-3 level with spinal cord compression. She underwent emergency C4-T2 laminectomy and hematoma removal, and achieved full recovery on the 11^th day after operation without obvious complication. Conclusions: Gua sha at the cervicothoracic and thoracolumbar regions should be done carefully. Sudden change in venous pressure may lead to epidural venous plexus rupture, and even spinal epidural hematoma. Emergency surgical decompression is widely accepted for symptomatic spinal epidural hematoma. With immediate and adequate decompression, even patients with paraplegia can have a good prognosis.

並列關鍵字

Spinal epidural hematoma ； Gua sha ； paraplegia