儿童无骨折脱位型脊髓损伤7例  

Spinal cord injuries without radiologic abnormality in 7 children

作　　者：季涛云[1] 张萌[1] 包新华[1] 符娜[1] 吴晔[1] 王爽[1] 常杏芝[1] 熊晖[1] 姜玉武[1] 秦炯[1] 张月华[1] 

机构地区：[1]北京大学第一医院儿科,100034

出　　处：《中华实用儿科临床杂志》2014年第24期1901-1904,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的 总结儿童无骨折脱位型脊髓损伤（SCIWORA）的临床特点和预后,提高对该病的认识.方法 对7例临床确诊为SCIWORA的患儿进行回顾性分析及随访研究,总结其临床特点及预后.与同期17例急性脊髓炎患儿进行回顾性对比分析.结果 本组7例患儿.其中男3例,女4例;年龄4～9岁.发病前均有明确的诱因,诱因为轻微外力,损伤后病情进展迅速,均表现为截瘫、感觉障碍及尿便潴留.脊髓MRI显示3例为胸髓受累,3例为胸髓、腰髓受累,1例为颈髓、胸髓、腰髓损伤,受累部位为T1WI低信号,T2WI高信号.发病初均被误诊为急性脊髓炎,治疗效果差,随访8个月～9年5个月,预后差,患儿肢体无力及尿便潴留均无好转.SCIWORA组患儿多有明确诱因（外伤）,病情进展迅速,为横贯性脊髓损伤表现,受累部位多包含腰髓,与急性脊髓炎组患者比较差异有统计学意义.结论 儿童轻微外力所致SCIWORA,以胸、腰段脊髓受累为主,进展迅速,多为横贯性脊髓损伤表现,易被误诊,预后差。Objective To summarize the clinical features and the prognosis of spinal cord injuries without radiologic abnormality（SCIWORA） in children,so as to improve the pediatrician＇s further understanding about this disease.Methods The clinical features,therapeutic regimen and prognosis of 7 children with SCIWORA were summarized by a retrospective and follow-up study.The clinical features of 7 patients with SCIWORA were compared with those of 17 patients with acute myelitis.Results Among the 7 patients with SCIWORA,3 cases were male and 4 cases were female.Their age varied from 4 to 9 years.Before onset,all the patients had clear incentives which were minor trauma.The common symptoms were paraplegia,sensory disturbance and retention.The MRI of spinal displayed 3 patients with injury in thoracic spinal cord,3 patients with injury in thoracic and lumbar spinal cord,and 1 patient with injury in cervical,thoracic and lumbar spinal cord.The MRI displayed hypo-intense signals in T1-weighted image（T1WI） and hyper-intense signals in T2-weighted image（T2WI） in all injured segments of spinal cord.The patients were followed up for 8 months to 9 years and 5 months.The prognosis of the patients was poor.Weakness and urine retention in all patients were not improvement.Patients with SCIWORA had clear incentives,rapid prgrssion,manifestations of the transverse spinal cord injury and injure in lumbar spinal cord,and there were significant differences compared to the patients with acute myelitis.Conclusions SCIWORA in children caused by mild external force mainly injured thoracic and lumbar spinal cord.Most patients are presented with the symptoms of transverse myelitis.SCIWORA is often misdiagnosed and the prognosis is poor.

关 键 词：无骨折脱位型脊髓损伤 诱因 糖皮质激素 儿童 

分 类 号：R726.5[医药卫生—儿科]