創傷性頸椎椎間盤脫出合併硬膜外膿瘍致四肢麻痺的診斷及復健治療一病例報告

Diagnosis and Rehabilitation of Traumatic Cervical Disc Herniation with Epidural Abscess Resulting in Quadriplegia: A Case Report

洪禎雯(Jen-Wen Hung) ； 楊百嘉(Baii-Jia Yang)

《中華民國復健醫學會雜誌》 20期 (1992/12) Pp. 209-213

https://doi.org/10.6315/JRMA.199212.0012

摘要

這是一個67歲、男性、糖尿病患者，因酒後跌倒導致創傷性第三、四頸椎椎間盤突出併硬膜外膿瘍，於椎間盤切除手術後四肢全癱、呼吸困難需仰賴呼吸器而住進加護病房。除了例行的復健工作外，本例還嘗試用表皮電刺激坤助其肌力的恢復及脫離呼吸器。兩個月後病人復原至呼吸正常，半年後肌力恢復至可用助行器行走，一年後肌力完全恢復。 對於這類病人的預後，一般認為與神經學變化的嚴重程度及手術各處的時間快慢有關。本例術前雖四肢全癱，但仍保有針刺感，且在出現無力48小時內即診斷出來接受手術。由於嚴重的高位頸髓壓迫，術後發生呼吸困難需用呼吸器，同時產生許多內科併發症，是個較一般頸椎硬膜外膿瘍嚴重的病例。由於早期手術及術後的早期復健，特別是電刺激治療，使肌力較易恢復。雖僅此一病例，提出來希望能拋磚引玉，而有其他這類報告，進進一步的探討。

關鍵字

硬膜外膿瘍 ； 椎間盤突出 ； 表皮電刺激

並列摘要

This 67 years old, male, DM patient suffered from a falling accident, resulting in traumatic cervical disc herniation with epidural abscess. After discectomy, the patient sustained quadriplegic condition and needed mechanical ventilation due to breathing difficulty. In addition to the usual rehabilitation program, we also used transcutaneous electrical stimulation on this patient's various muscle groups in order to stimulate his muscles and to help his weaning from ventilator. Two months later, the patient's breath was normal, and half year later he could walk with walker. His muscle power was normal one year later. The severity of the neurological lesion and the timing of operation influence the prognosis of cervical disc herniation with epidural abscess. This patient was quadriplegic before the operation, but pinprick sensation was preserved, and he was operated within 48 hours when this progressive quadriplegic condition developed. In spite of quadriplegia, he developed many medical complication and depended on ventilator for several months, but the recovery of this case was rather well. It may be due to 1)operation on time 2)rehabilitation given promptly post-operation and 3)the suitable electrical stimulation program.