儿童无放射学影像异常的脊髓损伤14例临床分析  

The clinical analysis of 14 children with spinal cord injury without radiographic abnormality

作　　者：郑华[1] 伍云[1] 韩彤立[1] 邹丽萍[1] 

机构地区：[1]首都医科大学附属北京儿童医院神经内科与康复中心,北京市100045

出　　处：《中国脊柱脊髓杂志》2007年第6期433-436,共4页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:提高对儿童无放射学影像异常的脊髓损伤(spinal cord injury without radiographic abnormality,SCIWORA)的认识。方法:对1992年1月至2005年8月北京儿童医院住院患者中诊断为“急性脊髓炎”或“脊髓损伤”的187例进行回顾性分析,发现其中14例为SCIWORA。男6例,女8例。年龄1岁3个月～15岁(15岁1例,1岁3个月～7岁13例)。均有明确外伤史。损伤水平在C6～T9,颈髓2例,胸髓12例。脊髓功能ASIA分级:A级9例,C级4例,D级1例。脊柱X线片和CT未见骨折及脱位;MRI检查示脊髓水肿9例,脊髓出血2例,脊髓挫伤3例。采用综合治疗,包括卧床、局部制动,应用激素、脱水剂、神经营养药等。结果:4例患者失访,10例患者随访6个月～5年,平均2年3个月,4例(C级3例,D级1例)患者(均为MRI显示水肿局限者)在伤后6个月运动、感觉及括约肌功能完全恢复(E级);6例(A级)患者运动、感觉及括约肌障碍未恢复。2例(A级)病初MRI表现为脊髓弥漫水肿者,伤后4～6个月复查MRI脊髓呈萎缩样改变。结论:对怀疑SCIWORA的儿童,应首选MRI检查。脊髓水肿局限者预后好,水肿弥漫或伴有出血、挫伤者预后差。Objective：To increase the cognition about spinal cord injury in children without radiographic abnormality.Method：A retrospective study was performed for 187 patients who had been diagnosed as ＂acute myelitis＂ or ＂spinal cord injury＂ in the Beijing Children＇s Hospital from January 1992 to August 2005.There were 14 cases diagnosed as spinal cord injury without radiographic abnormality （SCIWORA）.There were 6 males and 8 females.The age of patients were from 1 year and 3 months to 15 years（1 case was 15 years, the other 13 cases was from 1 year and 3 months to 7 years）.All cases had the traumatic history.The level of injury ranges from C6 to T9 with 2 of them in cervical spinal cord, 12 of them in thoracic spinal cord.According to ASIA spinal cord functional classification：9 cases were in grade A,4 cases in grade C,1 case in grade D.The spinal cord of each patient showed no abnormal on X-ray and CT scan.MRI findings included 9 cases of edema,2 cases of hemorrhage and 3 cases of contusion.All cases were administered with bedrest, immobilization,methylprednisolone and neurotrophin medicine.Result：4 cases were lost during follow-up,the other 10 cases were followed up for an average period of 27 months（range,6～60 months）.4 cases（3 cases of grade C ,1 case of grade D） had complete neurological recovery at 6th month after injury,6 cases （grade A） had no neurological recovery.2 cases with spread spinal cord edema in MRI had evidence of spinal cord atrophy 4～6 months after injury.Conclusion：For children suspected as SCIWORA,MRI is the first choice,the patients with localized edema in spinal cord have good outcome,while those with spread edema or complicated with hemorrhage or contusion will have bad outcome.

关 键 词：脊髓损伤 无放射学影像异常脊髓损伤 脊髓水肿 脊髓萎缩 

分 类 号：R683.2[医药卫生—骨科学] R744[医药卫生—外科学]