CAJ | 학술논문

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.
목적 총결인동무골절탈위형척수손상(SCIWORA)적림상특점화예후,제고대해병적인식.방법 대7례림상학진위SCIWORA적환인진행회고성분석급수방연구,총결기림상특점급예후.여동기17례급성척수염환인진행회고성대비분석.결과 본조7례환인.기중남3례,녀4례;년령4～9세.발병전균유명학적유인,유인위경미외력,손상후병정진전신속,균표현위절탄、감각장애급뇨편저류.척수MRI현시3례위흉수수루,3례위흉수、요수수루,1례위경수、흉수、요수손상,수루부위위T1WI저신호,T2WI고신호.발병초균피오진위급성척수염,치료효과차,수방8개월～9년5개월,예후차,환인지체무력급뇨편저류균무호전.SCIWORA조환인다유명학유인(외상),병정진전신속,위횡관성척수손상표현,수루부위다포함요수,여급성척수염조환자비교차이유통계학의의.결론 인동경미외력소치SCIWORA,이흉、요단척수수루위주,진전신속,다위횡관성척수손상표현,역피오진,예후차.
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.