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目的探讨儿童无放射影像骨折脱位脊髓损伤(SCIWORA)的临床特征及早期诊断要点。方法对本院1997年2月-2008年8月11例住院SCIWORD患儿进行回顾性研究,分析患儿的致伤方式、起病过程、症状、体征、影像学及其他检查结果 ,总结其共同的临床特征。结果本组患儿发病年龄1岁1个月～7岁,外伤原因为臀部/腰部受击打3例,剧烈蹦跳、跌倒臀部着地、跳舞做后下腰动作各2例,高处跳下、颈部过度后伸各1例;无前驱感染史;9例于外伤后即刻至30min内起病,7例出现脊髓完全横贯性损害,4例为不完全性脊髓损伤,肌力Ⅱ～Ⅳ级;起病后无发热或仅有短时低热;进展期不超过24h;影像学检查无髓外组织受损表现,7例磁共振见脊髓内异常信号;脑脊液检查4例正常,2例见红细胞增多。急性期6例被误诊为急性脊髓炎。4例远期随访无恢复。结论儿童SCIWORA具有独特的生物力学发病机制,一些轻微外伤常被忽视,易被误诊为急性脊髓炎,儿童SCIWORA神经功能损害严重,应尽早采用合理治疗方案。
Objective To investigate the clinical features and early diagnosis of children with non-radiographic fracture and dislocation of spinal cord injury (SCIWORA). Methods A retrospective study was conducted on 11 hospitalized children with SCIWORD from February 1997 to August 2008 in our hospital. The methods of injury, onset, symptoms, signs, imaging and other examinations were analyzed, and their common findings were summarized The clinical features. Results The age of onset of this group was 1 year and 1 month to 7 years old. The cause of trauma was 3 cases of hips and lumbar injuries. The patients were briskly jumping and falling on the buttocks. 2 One case of excessive extension of the Ministry; no history of prodromal infection; 9 cases of onset within 30min after trauma, complete traumatic spinal cord injury in 7 cases, 4 cases of incomplete spinal cord injury, muscle strength Ⅱ ~ Ⅳ level; No fever or only short-term hypothermia after onset; no progress more than 24h; no abnormalities of extramedullary tissue in imaging examination, abnormal signal of spinal cord in 7 cases of MRI; normal in cerebrospinal fluid examination, normal erythrocyte in 2 cases . Six cases were acutely diagnosed as acute myelitis. 4 cases of long-term follow-up no recovery. Conclusion Children SCIWORA has a unique biomechanical mechanism. Some minor traumatic injuries are often overlooked and easily misdiagnosed as acute myelitis. Children with SCIWORA have severe neurological damage. Reasonable treatment should be adopted as soon as possible.