以螺丝刀自刺颈部致穿透伤并伴上颈段脊髓近全断裂而未累及颈部大血管的自杀未遂：临床病例

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本文报道了一例临床病例：一名40岁男性在被诊断为肿瘤性疾病后，使用螺丝刀对自身颈部造成穿透性损伤。文章阐述了患者急诊救治过程中采取的措施，描述了所实施的影像学检查及伤口的外科处理顺序，并重点指出了颈椎损伤患者救治中的若干问题。

患者入院时，尽管螺丝刀仍滞留于颈部侧方，但意识清楚，血流动力学稳定。计算机断层扫描显示，在第II–III颈椎水平存在穿透性损伤，伴脊髓断裂，且未发现颈部大血管损伤。 在全身麻醉下实施急诊手术，取出异物并对患者状态进行稳定处理。螺丝刀取出过程中未观察到并发症。尽管患者初始状态稳定，但随后由于上颈段脊髓损伤引起的呼吸功能不全，病情逐渐恶化。数日后，患者因脊髓损伤相关并发症及自主呼吸功能丧失而死亡。

通过该病例可以评估穿透性颈椎损伤患者的诊治复杂性。此外，即使未累及颈部大血管，发生于第II–III颈椎水平的损伤亦可迅速导致危及生命的神经系统后果。对于上颈段脊髓损伤患者，及时开展器械性诊断检查并提供由不同专科医生参与的综合医疗救治具有至关重要的意义。然而，即便采取上述措施，患者的预后仍然不良。

作者简介

Manuela Montatore

Foggia University School of Medicine

Email: manuela.montatore@unifg.it
ORCID iD: 0009-0002-1526-5047
意大利, Foggia

Federica Masino

Foggia University School of Medicine

Email: federicamasino@gmail.com
ORCID iD: 0009-0004-4289-3289
意大利, Foggia

Antonio Zagaria

“Dimiccoli” Hospital

Email: antoniozagaria2015@gmail.com
ORCID iD: 0009-0002-2678-3659
意大利, Barletta

Marina Balbino

Foggia University School of Medicine

Email: marinabalbino93@gmail.com
ORCID iD: 0009-0009-2808-5708
意大利, Foggia

Francesco S. Guerra

Foggia University School of Medicine

Email: francesco.rino@gmail.com
ORCID iD: 0000-0003-3923-3429
意大利, Foggia

Giuseppe Guglielmi

Foggia University School of Medicine; “Dimiccoli” Hospital; “IRCCS Casa Sollievo della Sofferenza” Hospital

编辑信件的主要联系方式.
Email: giuseppe.guglielmi@unifg.it
ORCID iD: 0000-0002-4325-8330

MD, Professor

意大利, Foggia; Barletta; San Giovanni Rotondo

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2. Fig. 1. Results of a CT scan: a — coronal projection; b — sagittal projection. The metal part of the screwdriver is visible, oriented in the caudal-cranial direction from front to back towards the brain stem.

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3. Fig. 2. Images obtained by volumetric reconstruction from different angles: from behind (a) — the position of the tip of the screwdriver relative to the joint at the level of the I–II cervical vertebrae; right (b) and right below (c) — direction of the metal part of the screwdriver and absence of damage to the carotid artery; front (d) — general view of the patient's frontal plane.

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4. Fig. 3. Results of computed tomography without contrast enhancement in the coronal (a) and sagittal (b) planes: the tip of the screwdriver is inside the spinal canal and penetrates the upper sections of the spinal cord.

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5. Fig. 4. Computed tomography results in the axial plane, without contrast enhancement (a) and with contrast enhancement (b): the images before and after the administration of the contrast agent show the direction of the screwdriver obliquely through the soft tissues of the lateral surface of the neck into the spinal canal. There are no abnormal foci of contrast agent accumulation, indicating that the vascular structures are intact.

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6. Fig. 5. Postoperative computed tomography images in the coronal (a, c) and sagittal (b, d) planes confirm the removal of the foreign body with residual damage to the spinal cord and changes in the soft tissues.

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