喉癌术后放疗后并发化脓性脊柱炎、四肢瘫痪和致命性出血的颈椎放射性骨坏死：一例病例报告
Cervical spine osteoradionecrosis complicated by pyogenic spondylitis, quadriplegia, and fatal hemorrhage following postoperative radiotherapy for laryngeal carcinoma: a case report.
文献信息
| PMID | 42747456 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Dan Wang |
| 作者单位 | Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, 264000, Yantai, China. |
| 期刊 | Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] |
| SCI 分区 | Q2 |
| IF | 2.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 颈椎放射性骨坏死（ORN）是头颈部放疗后一种罕见但严重的并发症。它可能并发继发感染，导致神经功能损害和严重的血管并发症。我们报告一例喉癌术后辅助放疗7年后发生的颈椎ORN。
病例介绍： 一名70岁男性，有控制不佳的2型糖尿病和高血压病史，既往因声门型喉癌接受过部分喉切除术和颈淋巴结清扫术，术后行螺旋断层放疗。7年后，他出现颈部疼痛、发热和四肢进行性无力。颈椎CT和MRI显示C4-C7椎体破坏性改变，C5/6椎间隙和椎前软组织内积气，以及提示感染性受累的表现。血培养检出星座链球菌。诊断为颈椎ORN并发化脓性脊柱炎、颈脊髓损伤和四肢瘫痪。患者接受了气管切开术、颈部探查术、深部颈部脓肿切开引流术和坏死组织清创术。尽管实现了感染控制并部分神经功能改善，但随后他出现了反复发作的大量口鼻出血，最终死于失血性休克。
结论： 本病例强调，在头颈部放疗后的长期随访中，需要持续警惕迟发性颈椎ORN和继发感染。对于出现新发颈部疼痛、发热或神经功能缺损的患者，应早期进行CT、MRI评估，并在怀疑血管受累时进行CTA检查，以促进及时干预。
英文摘要
BACKGROUND: Cervical spine osteoradionecrosis (ORN) is a rare but serious complication after head and neck radiotherapy. It may be complicated by secondary infection, leading to neurological impairment and severe vascular complications. We report a case of cervical spine ORN occurring 7 years after postoperative adjuvant radiotherapy for laryngeal carcinoma.
CASE PRESENTATION: A 70-year-old man with a history of poorly controlled type 2 diabetes mellitus and hypertension had previously undergone partial laryngectomy and neck dissection followed by postoperative helical tomotherapy for glottic laryngeal carcinoma. Seven years later, he presented with neck pain, fever, and progressive weakness of all four limbs. Cervical CT and MRI showed destructive changes of the C4-C7 vertebral bodies, gas in the C5/6 intervertebral space and prevertebral soft tissues, and findings suggestive of infectious involvement. Blood culture yielded Streptococcus constellatus. A diagnosis of cervical spine ORN complicated by pyogenic spondylitis, cervical spinal cord injury, and quadriplegia was made. The patient underwent tracheotomy, neck exploration, incision and drainage of a deep neck abscess, and debridement of necrotic tissue. Although infection control and partial neurological improvement were achieved, he subsequently developed recurrent massive oral and nasal hemorrhage and ultimately died of hemorrhagic shock.
CONCLUSIONS: This case highlights the need for continued vigilance for delayed cervical spine ORN and secondary infection during long-term follow-up after head and neck radiotherapy. In patients presenting with new-onset neck pain, fever, or neurological deficits, early evaluation with CT, MRI, and, when vascular involvement is suspected, CTA should be performed to facilitate timely intervention.