CAJ | 학술논문

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.
배경:무방사영상이상경척수손상위척수손상적일충특수류형.유우처우생장발육계단적인동재해부학화생물역학방면적특수성,기손상궤제급치료방법여성인적유소불동.목적:탐토인동신선무방사영상이상경척수손상적림상특점급치료.설계:회고성분석급자신전후대조관찰.단위:합이빈의과대학부속제이의원척주외과.대상:1997-06/2003-06합이빈의과대학부속제이의원척주외과수치적무방사영상이상경척수손상환자14례.납입표준:①림상표현위불동정도적감각、운동급괄약기공능장애.②경추X사선평편、MRI검사,미발현골절탈위.MRI검사현시척수손상정상,T1WI척수증조,T2WI연척수장축분포조상형고신호구,병향상하만연.척수완전성손상환자3례,불완전성손상11례.재척수불완전성손상중,6례표현위중앙척수손상종합정,3례위척수반절손상종합정,2례위전척수손상종합정.방법:대14례인동무방사영상이상경척수손상환자진행회고성분석,채취비수술치료13례,경후로환추추융합술1례.주요관찰지표:환자치료전후ASIA분급정황.결과:사망1례,13례획평균3년수방.무명현개선자3례,기여환자지체공능균유불동정도적회복.근거ASIA분급표준,치료전A급자3례,B급자5례,C급자5례,D급자1례.치료후회복지B급자1례,C급자2례,D급자5례,E급자2례.결론:인동무방사영상이상경척수손상신경공능회복정황여척수원발성손상정도밀절상관,다수환자이비수술치료위주,대존재경추명현불은환자가채용수술치료.
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 Departmentof 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 prosenchyma 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 2withfrontal 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 grading standard, before treatment there were 3 cases in A grade, 5 cases in B grade, 5 cases in C grade and 1 case in D grade, and after treatment there were 1 case recovering to B grade, 2 cases to C grade, 5 cases to D grade and 2 cases to E grade.CONCLUSION: Restoration of neurofunction of children with cervical SCIWORA has closely correlation with degree of primary injury of spinal cord. Most of the patients were not treated with operation, and those with obviously instable cervical vertebra can be treated with operation.