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目的:提高对儿童无放射学影像异常的脊髓损伤(spinal cord injury without radiographic abnormality,SCIWORA)的认识。方法:对1992年1月至2005年8月北京儿童医院住院患者中诊断为“急性脊髓炎”或“脊髓损伤”的187例进行回顾性分析,发现其中14例为SCIWORA。男6例,女8例。年龄1岁3个月～15岁(15岁1例,1岁3个月～7岁13例)。均有明确外伤史。损伤水平在C6～T9,颈髓2例,胸髓12例。脊髓功能ASIA分级:A级9例,C级4例,D级1例。脊柱X线片和CT未见骨折及脱位;MRI检查示脊髓水肿9例,脊髓出血2例,脊髓挫伤3例。采用综合治疗,包括卧床、局部制动,应用激素、脱水剂、神经营养药等。结果:4例患者失访,10例患者随访6个月～5年,平均2年3个月,4例(C级3例,D级1例)患者(均为MRI显示水肿局限者)在伤后6个月运动、感觉及括约肌功能完全恢复(E级);6例(A级)患者运动、感觉及括约肌障碍未恢复。2例(A级)病初MRI表现为脊髓弥漫水肿者,伤后4～6个月复查MRI脊髓呈萎缩样改变。结论:对怀疑SCIWORA的儿童,应首选MRI检查。脊髓水肿局限者预后好,水肿弥漫或伴有出血、挫伤者预后差。
Objective: To improve the understanding of children with non-radiographic abnormal spinal cord injury (SCIWORA). Methods: A retrospective analysis of 187 inpatients diagnosed as “acute myelitis” or “spinal cord injury” at Beijing Children’s Hospital from January 1992 to August 2005 was performed and 14 of them were found to be SCIWORA. 6 males and 8 females. 1 year old 3 months to 15 years old (1 case of 15 years old, 1 year old 3 months to 7 years old in 13 cases). Have a clear history of trauma. Injury levels in the C6 ~ T9, cervical spinal cord in 2 cases, 12 cases of chest. Spinal cord function ASIA classification: A grade in 9 cases, C grade in 4 cases, D grade in 1 case. Spinal X-ray and CT no fracture and dislocation; MRI showed spinal cord edema in 9 cases, 2 cases of spinal cord hemorrhage, spinal cord contusion in 3 cases. The use of comprehensive treatment, including bed rest, partial braking, application of hormones, dehydrating agents, neurotrophic drugs. Results: Four patients were lost to follow-up. Ten patients were followed up for 6 months to 5 years with an average of 2 years and 3 months. Four patients (3 patients with grade C and 1 patient with grade D) Six months after injury, motor, sensory and sphincter functions recovered completely (Grade E); exercise, sensory and sphincter disturbances were not restored in six patients (Grade A). In 2 cases (Grade A), the first MRI showed diffuse edema of the spinal cord and the atrophy of the MRI spinal cord after 4 to 6 months after injury. Conclusion: For children suspected of SCIWORA, MRI should be the first choice. Spinal cord edema limited prognosis, diffuse or associated with edema, contusion, poor prognosis.