閃電擊傷所造成合併脊髓神經及周邊神經病變－個案報告及簡短文獻回顧

Combined Spinal Cord Myelopathy and Diffused Axonal Polyneuropathy after Lightning Injury-A Case Report and Brief Literatures Review

林彥斌(Yen-Pin Lin) ； 楊瑞永(Jui-Yung Yang)

《臺灣整形外科醫學會雜誌》 22卷4期 (2013/12) Pp. 357-364

摘要

背景：閃電擊傷之後所造成的傷害與可能需要的重建，大部分都屬於整形外科醫療的範疇，因此，增加對於此類傷害的了解對整形外科醫師來說是有其必要性的。目的及目標：這篇個案報告的目的在於分享此一罕見的情況，在此，作者藉由提出一個遭閃電直接擊傷後成功存活，並合併脊髓和周邊神經病變的個案，同時做些文獻回顧，以分享此罕見但危急的特殊情況的相關知識。材料及方法：我們報告了一位六十一歲的男性，於登山時遭遇雷擊，送達本院時已產生橫紋肌溶解症以及急性腎衰竭，並合併下肢癱瘓，於住院過程中右下肢因嚴重電灼傷產生廣泛性軟組織壞死，於數次清創手術後許多重要結構外露。結果：有少數個案報告在高壓電傷合併下肢癱瘓後逐漸恢復運動功能的案例，我們遂藉由游離皮瓣重建手術成功保留其右下肢。結論：閃電擊傷所可能引起的神經系統損傷涵蓋極廣，極富變化，在此所提出的個案為合併周邊神經損傷以及高位脊髓傳導缺陷而導致下肢癱瘓的情況，更屬罕見，有鑑於少數成功恢復的個案報導，若發生肢體嚴重損傷，即使當時病患該肢體癱瘓，仍應積極保留。

關鍵字

閃電傷 ； 電傷 ； 電擊傷 ； 脊髓損傷 ； 周邊神經損傷 ； 下肢癱瘓 ； 游離皮瓣 ； 下肢重建

並列摘要

Background:The majority of lightning injuries are within the treatment purview of the plastic surgeon. Therefore, we must know better about these injuries.Aim and Objectives:Here we presented a rare case of combined spinal cord injury and peripheral polyneuropathy and doing a brief literatures reviewing.Materials and Methods:A 61 y/o male stuck by lightning while mountain climbing with initial presentation of rhabdomyolysis, acute renal failure and paraplegia. During admission, right lower leg extended soft tissue necrosis was noted. Bones, vessels, nerves and tendons exposure was noted after series of debridement.Results:Due to the paraplegia caused by high voltage electrical injury may have the chance to get recovered, we reconstructed the defect with free flap and successfully preserved his right lower leg.Conclusion:The possible neurological injuries caused by lightning vary a lot. This case of combined spinal cord injury and peripheral polyneuropathy is rare. According to several case reports about recovery from paraplegia after electrical injuries, we suggested aggressive preserve the damaged extremities even though the limb was paralyzed at that time.

並列關鍵字

lightning injuries ； electrical burns ； electrical injuries ； spinal cord injuries ； peripheral neuropathy ； paraplegia ； free flap ； lower extremities reconstruction