无骨折脱位儿童新鲜颈脊髓损伤的保守治疗(英文)  

Expectant treatment of fresh cervical spinal cord injury in children with non-fracture dislocation

作　　者：鲁鸿燕[1] 王松彦[1] 齐华[1] 白琳[1] 徐洋[1] 

机构地区：[1]哈尔滨医科大学附属第二医院脊柱外科,黑龙江省哈尔滨市150086

出　　处：《中国临床康复》2006年第20期165-167,共3页Chinese Journal of Clinical Rehabilitation

摘　　要：背景:无放射影像异常颈脊髓损伤为脊髓损伤的一种特殊类型。由于处于生长发育阶段的儿童在解剖学和生物力学方面的特殊性,其损伤机制及治疗方法与成人的有所不同。目的:探讨儿童新鲜无放射影像异常颈脊髓损伤的临床特点及治疗。设计:回顾性分析及自身前后对照观察。单位:哈尔滨医科大学附属第二医院脊柱外科。对象:1997-06/2003-06哈尔滨医科大学附属第二医院脊柱外科收治的无放射影像异常颈脊髓损伤患者14例。纳入标准:①临床表现为不同程度的感觉、运动及括约肌功能障碍。②颈椎X射线平片、MRI检查,未发现骨折脱位。MRI检查显示脊髓损伤征象,T1WI脊髓增粗,T2WI沿脊髓长轴分布条状形高信号区,并向上下蔓延。脊髓完全性损伤患者3例,不完全性损伤11例。在脊髓不完全性损伤中,6例表现为中央脊髓损伤综合征,3例为脊髓半切损伤综合征,2例为前脊髓损伤综合征。方法:对14例儿童无放射影像异常颈脊髓损伤患者进行回顾性分析,采取非手术治疗13例,颈后路寰枢椎融合术1例。主要观察指标:患者治疗前后ASIA分级情况。结果:死亡1例,13例获平均3年随访。无明显改善者3例,其余患者肢体功能均有不同程度的恢复。根据ASIA分级标准,治疗前A级者3例,B级者5例,C级者5例,D级者1例。治疗后恢复至B级者1例,C级者2例,D级者5例,E级者2例。结论:儿童无放射影像异常颈脊髓损伤神经功能恢复情况与脊髓原发性损伤程度密切相关,多数患者以非手术治疗为主,对存在颈椎明显不稳患者可采用手术治疗。BACKGROUND： Cervical spinal cord injury without radiographic abnormality （SCIWORA） is a special type of spinal cord injury. Because of the particularity of children in the period of growth and development on the aspects of anatomy and biomechanics, their injured mechanism and therapeutic method differ from those of adults. OBJECTIVE： To explore clinical feature and therapy of first-episode cervical SCIWORA in children. DESIGN： Retrospective analysis and self pre-and post-control observation. SETTING： Department of Spine Surgery, Second Affiliated Hospital, Harbin Medical University. PARTICIPANTS： Totally 14 patients with cervical SCIWORA, who were treated at the Department of Spine Surgery, Second Affiliated Hospital, Harbin Medical University between June 1997 and June 2003. Inclusive criteria： ①patients who had dysfunction of sensation, exercise and sphincter to different degree in clinic, ②patients who had no fracture dislocation after cervical vertebra X-ray plain film and MRI examination. The MRI examination showed the sign of spinal cord injury. T1WI spinal cord became thick. T2WI distributed at strip-shape high-signal region along spinal pros- enchyma and spread upward and downward. There were 3 patients with complete spinal cord injury and 11 patients with incomplete spinal cord injury, among the patients with incomplete injury, there, were 6 patients with central cord syndrome （CCS）, 3 with Brown-Sequard syndrome and 2 with frontal spinal cord injury syndrome. METHODS： Retrospective analysis was performed in 14 children patients with cervical SCIWORA. Thirteen patients were not treated with operation and one patient was treated with cervical posterior atlantoaxial fusion. MAIN OUTCOME MEASURES： ASIA grading before and after treatment in patients. RESULTS： There were 1 dead patient and 13 cases with 3-year follow up averagely. Three patients were with insignificant amelioration, and others had recovery of limb function to different degree. According to ASIA grad

关 键 词：体层摄影术 X线 颈 脊髓损伤 治疗 儿童 

分 类 号：R651.2[医药卫生—外科学]