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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。
Background: No radiographic abnormalities Cervical spinal cord injury is a special type of spinal cord injury. Due to the special anatomy and biomechanics of children in their growth and development stage, their mechanisms of injury and treatment are different from those of adults. Objective: To investigate the clinical features and treatment of fresh non-radiological abnormal cervical spinal cord injury in children. Design: retrospective analysis and before and after its own control. Unit: Spine Surgery, Second Affiliated Hospital of Harbin Medical University. PARTICIPANTS: A total of 14 patients without radiographic abnormal cervical spinal cord injury admitted to Department of Spine Surgery, Second Affiliated Hospital of Harbin Medical University from June 1997 to June 2003 were enrolled. Inclusion criteria: ① clinical manifestations of varying degrees of sensory, motor and sphincter dysfunction. ② cervical X-ray plain film, MRI examination, no fracture and dislocation. MRI showed signs of spinal cord injury, T1WI spinal cord thickening, T2WI distribution along the long axis of the spinal cord strip high signal area, and spread up and down. 3 cases of complete spinal cord injury, 11 cases of incomplete injury. In the incomplete spinal cord injury, 6 cases showed central spinal cord injury syndrome, 3 cases of spinal cord hemisection injury syndrome, 2 cases of anterior spinal cord injury syndrome. Methods: A retrospective analysis was performed on 14 cases of children without radiographic abnormal cervical spinal cord injury. Thirteen cases were treated by non-surgical treatment and one case was treated by atlantoaxial cervical fusion. MAIN OUTCOME MEASURES: ASIA classification before and after treatment. Results: 1 patient died and 13 patients were followed up for an average of 3 years. No significant improvement in 3 cases, other patients have different degrees of limb function recovery. According to the ASIA grading standards, there were 3 cases of grade A before treatment, 5 cases of class B, 5 cases of class C, and 1 case of class D. After treatment, patients recovered to grade B in 1 case, grade C in 2 cases, grade D in 5 cases and grade E in 2 cases. CONCLUSION: The neurological function recovery of cervical spinal cord injury without radiographic abnormality in children is closely related to the degree of primary injury of spinal cord. Most of the patients are treated non-surgically, and surgical treatment of patients with obvious unstable cervical spine may be used.