背痛手麻莫輕忽，醫師成功搶救罕症

新聞編採：
新聞翻譯：Amy Yang
旁白配音：羅綺梅

Back pain and hand numbness: don’t ignore the symptoms

這是花東一個「自發性脊椎硬膜外出血-合併脊髓壓迫症候群」手術成功的案例，病患重拾生機獻花感謝。神經外科廖正智醫師表示，這種急症相當罕見，比較癌症發生率10萬人/268.7人來看，約是癌症盛行率的1/2000，即便發生率非常的低，但還是要小心。

This is the story of a patient in Eastern Taiwan who was successfully treated for spinal cord compression syndrome caused by spontaneous spinal epidural hematoma. The patient came back to the hospital with flowers to thank her doctor. According to her neurosurgeon Dr. Zhengzhi Liao, this disease is extremely rare and you are 2000 times more likely to get cancer, which affects 268.7 out of 100,000 people. Although the chances of getting this disease is very low, care should still be taken.

不明原因突發性的肩頸撕裂疼痛，醫師搶救

Hospitalized for a sudden tearing pain in the neck

張女士在今年1月間晚餐後感到突發性肩頸撕裂痛，並約在1小時之後感到漸行性四肢麻木並無力，2小時之後因上肢無力、左手無法拿碗吃飯遂至門諾急診就醫。經檢查後發現頸椎內大片硬膜外出血-合併脊髓壓迫症。經門諾急診團隊立即會診神經外科醫師並緊急開刀後，病患順利完成手術，張女士特別出席獻花給主治醫師廖正智，感謝其救命之恩。

This January while Ms. Zhang was having dinner, she suddenly felt a tearing pain in her neck which was followed an hour later by numbness in her limbs. Two hours later when weakness in her upper limbs prevented her left hand from picking up the bowl to finish her dinner, she was sent to the emergency room at Mennonite Christian Hospital for treatment. It was discovered that there was extensive epidural hemorrhage within her cervical spine combined with spinal cord compression. The hospital’s emergency staff immediately consulted with a neurosurgeon who performed an emergency surgery. The surgery was a success, and Ms. Zhang later returned to the hospital with flowers to thank the attending
physician Dr. Liao for saving her life.

脊椎異常出血的變異性有高度風險

High risk from variability in abnormal spinal bleeding

門諾醫院院長吳鏘亮說：一般急重症常見的包括心肌梗塞和中風，在神經外科領域中，脊椎部分病變也有很緊急的，今天這罕見的個案，也可讓東部鄉親知道，脊椎的變異若有些情況若能趕快處理，跟癒後有很大差別。而負責這次手術的靈魂人物廖正智醫師則謙虛的說，非常感謝張女士信任團隊，讓自己在過去的專業訓練上可以及時發揮醫治功能。廖醫師說，張女士此次的疾病相當罕見，他個人曾經手7例，過去在長庚服務時，知道資料庫有50多例的2篇國際性論文報告。

Qiangliang Wu, superintendent of Mennonite Christian Hospital, said: “most cases that we see in the emergency room are myocardial infarctions and strokes; in the field of neurology, there are also emergency cases that involve the spine. Today’s rare case is a message to the locals in Eastern Taiwan that if changes in the spine are treated immediately, it will make a big difference in terms of recovery.” As for the neurosurgeon Dr. Zhengzhi Liao, hehumbly thanked Ms. Zhang for her faith in his team and for giving him the opportunity to offer timely treatment based on his past professional training. Dr. Liao said: “Ms. Zhang’s disease is extremely rare and I have personally handled seven cases. When I served at Chang Gung Hospital, I learned about it from the 50 or so cases from two international papers in the database.”

↑廖醫師說，張女士此次的疾病相當罕見，他個人曾經手7例，過去在長庚服務時，知道資料庫有50多例的2篇國際性論文報告。

Dr. Liao said: “Ms. Zhang’s disease is extremely rare and I have personally handled seven cases. When I served at Chang Gung Hospital, I learned about it from the 50 or so cases from two international papers in the database.”

沒有任何病史紀錄，仍有發生的可能

It may happen even with no medical history

因為罕見，國內民眾相對資訊與報導也比較欠缺。而張女士此次自發性脊椎硬膜外出血，主要是因產生的血塊壓迫到神經而影響四肢的感覺。症狀包括突發性肩頸撕裂痛然後慢慢演變成四肢無力，從無法拿碗、拿筷子、到雙手沒有感覺慢慢變成下半身沒感覺，演變速度很快。而門諾醫院的急診醫師也很有經驗，一開始就懷疑是急性脊髓壓迫病變的問題。廖醫師說，病患本身相當健康，沒有任何相關病史、甚至連高血壓、糖尿病都沒有，但因為喪失知覺的範圍擴大遂緊急安排手術，很順利在術後不到8小時，病患已完全恢復四肢知覺，並在24小時內可以自行下床走路。手術所採取的方式則是先將頸椎前一塊骨頭進行切除，主要是為了將脊髓硬膜外的血塊清除，手術範圍為頸椎第三節一直做到胸椎第一節，手術時間不長，但因為黃金時機掌握得宜，張女士恢復極佳。

Due to the rarity of this disease, there is a lack of public awareness and news reports. In Ms. Zhang’s case, her spontaneous spinal epidural hematoma was caused by a blood clot that compressed her nerves and affected feeling in her limbs. Her symptoms included a sudden tearing pain in her neck which gradually led to weakness in all four limbs. This quickly escalated into an inability to hold onto her bowl, her chopsticks, numbness in both hands, and finally to loss of feeling in her lower body. Thankfully, the emergency room doctor at Mennonite Christian Hospital was experienced and suspected spontaneous spinal epidural hematoma to be the problem. According to Dr. Liao, the patient was healthy with no prior medical history, not even high blood pressure or diabetes. Because the numbness had spread over a large area, surgery was immediately arranged, and the patient regained feeling in her limbs in less than eight hours after the surgery, and was able to walk about 24 hours later. The surgery was performed by removing a section of the first cervical vertebrae to remove the clot outside the spinal epidural. The extent of the surgery was from the third cervical vertebrae to the first thoracic vertebrae. As the duration of the surgery was not long and performed within the golden period, Ms. Zhang recovered extremely well.

↑照片範例：左邊為正常頸椎的脊髓正片照片，右邊四張為脊隨神經被不明血塊壓迫的正片照片（尤其是第五節與第六節）。

Sample photo: the left photo shows a normal cervical vertebrae; the four photos on the right show nerves in the spine being compressed by blood clots (especially on the 5th and 6th columns).

病患張女士今年64歲，他非常感謝廖醫師的救命之恩，她回憶當時罹病的心情說，一開始到急診還是用走的進來，沒多久四肢就慢慢失去知覺，那時心裡很害怕，老公在旁邊想要幫忙按摩還被罵，因為不知自己生了甚麼怪病，心裡非常非常恐懼。她說，在沒知覺的恐懼下很快進入手術室，但讓她最驚訝的是，一覺醒來，手腳居然就能動了！她在現場與先生不斷的向吳院長與廖醫師致謝，她說，因為家中還有一對老人家要照顧，萬一她倒下，就會是整個家庭的失序，張女士在術後沒多久就出院休養，也不需做復健，生活都已恢復正常，她一直說，這條命是廖醫師救回來的！

The patient Ms. Zhang is 64 this year, and she is very thankful to Dr. Liao for saving her life. She recalled that on the day, she was able to walk into the emergency room, but not long after gradually lost the feeling in her limbs. She felt very scared at the time, and even yelled at her husband for wanting to give her a massage. It was a frightening experience as she did not know what was causing the symptoms. She said that she was quickly rolled into surgery while still feeling afraid, but when she woke up, she was surprised that she was able to move her arms and legs again! She and her husband repeatedly thanked superintendent Wu and Dr. Liao, and said that she still had to take care of an elderly couple at home; if she did not get better, it would have been a nightmare for the entire family. Ms. Zhang went home to recuperate not long after the surgery and physiotherapy was not needed. Life has returned back to normal. She continuously emphasized: “Dr. Liao saved my life!”

↑醫師緊急評估張女士的狀況後，立即進行椎弓切除手術，與時間賽跑將脊隨中的血塊以最快的時間清除，降低病人脊損持續失能的可能性。

After an emergency evaluation of Ms. Zhang’s condition, vertebral arch removal surgery was immediately performed; it was a race against time to clear the blood clot from her spine to reduce the likelihood of sustained disability to the patient from spinal damage.

↑張女士現在作息都恢復正常，他非常感謝醫師能在這麼短的時間內，做出如此正確的判斷，讓他脫離可能癱瘓的風險。

Ms. Zhang’s daily routine is now back to normal. She is grateful to her doctor for making a correct judgement in such a short period of time to avoid the possible risk of paralysis.

成因不明，切莫輕忽生活中急性的肩頸疼痛

Don’t ignore acute neck pains with unknown cause

廖醫師也說，張女士這次疾病造成的原因，不是因為外傷造成，詳細原因至今仍不明，比較懷疑的方向，應該是胸、腹腔壓力突然的改變，例如：打噴嚏或咳嗽而造成一些微小血管出血，發生比例為10萬人中僅有0.1人發生。比較癌症發生率10萬人/268.7人，約癌症盛行率的1/2000。發生率極少，因此民眾不需特別擔心，但廖醫師也說，此症狀若超過12小時才就醫，有可能就會終身癱瘓，他呼籲民眾只要有感覺異常的肩頸、脊椎、腰椎痠麻就可以先到醫院檢查，了解疾病形成的原因，就可以在緊急意外發生時，做最快、最有效的治療。

According to Dr. Liao, Ms. Zhang’s disease was not caused by trauma; the exact reason is still unknown. It is more likely to be caused by a sudden change in pressure in the chest and abdominal cavity as sneezing or coughing can cause capillaries to burst, but chances are 0.1 out of 100,000 people. You are 2,000 times more likely to get cancer which affects 268.7 out of 100,000 people. As chances of getting spontaneous spinal epidural hematoma is extremely low, it is unnecessary to be especially worried. However, Dr. Liao also said that not treating the symptoms within 12 hours may lead to paralysis for life. He advised the importance of seeking medical attention if there is any soreness or numbness in the neck, spine, or waist. If a disease is caught early on, it can be quickly and effectively treated before it leads to a medical emergency.

背痛手麻莫輕忽，醫師成功搶救罕症／新聞編輯採訪：

關於Mch Public：門諾公益的編輯採訪群來自各種領域，包括醫管、電視媒體、平面媒體、出版編輯、社會工作、非營利組織的勸募工作者，大家抱持著對公益以及對偏鄉關懷的熱情，跳脫主流商業媒體的觀察，以公共議題為出發點，帶來更為深入的報導取向，讓許多無法被媒體關注的事件，從這個地方儘量的再現報導的真實，我們知道這裡的製作呈現無法追上主流媒體的豐富與精美，但我們會盡其所能，讓小角落的光傳遞的更遠，更深邃。