儿童胸椎结核的临床及影像学特点

Clinical features and imaging findings of thoracic spinal tuberculosis in children

目的:探讨儿童胸椎结核的临床及影像学特点,为其临床诊断和治疗提供参考。方法:1997年6月～2007年6月我院收治69例儿童胸椎结核患者,其中男36例,女33例,年龄1～14岁,平均5.9岁,对其临床及影像学特点进行归纳分析。根据脊髓神经功能受损与否分为截瘫组与脊髓神经功能正常组,比较其受累椎体数目。根据后凸Cobb角角度和患病节段分组,比较其截瘫率。结果:病程平均15.1个月,受累椎体平均3.2个,后凸Cobb角平均37.5°,合并截瘫26例(37.7%)。首诊原因以脊柱后凸畸形(34.8%)多见;常见症状以下肢症状(50.7%)多见,包括下肢无力、步态不稳等;常见体征以后凸畸形(92.8%)多见。截瘫组受累椎体数为3.6±1.5(2～8)个,多于脊髓神经功能正常组的2.9±1.0(2～6)个,有显著性差异(P<0.05);上胸椎结核截瘫率为84.6%(11/13),高于中下胸椎结核的26.8%(15/56),有显著性差异(P<0.05);后凸Cobb角≥30°者截瘫率为45.8%(22/48),高于后凸Cobb角<30°者的截瘫率19.0%(4/21),有显著性差异(P<0.05);病程、受累椎体数、后凸角度间有相关性(相关系数r为0.338～0.535,P<0.05)。35例胸椎MRI示2个或2个以上相邻椎体T1低信号,T2高或混杂信号;椎旁软组织影边缘清楚,T1低信号,T2高或混杂信号;受累椎间盘消失或T2低信号。MRI对椎间盘受累及椎管受累的显示优于X线平片及CT(P<0.05)。结论:儿童胸椎结核早期易延误诊断,易导致严重后凸畸形。截瘫的危险因素包括上胸椎、多椎体受累和后凸Cobb角≥30°。MRI检查有助于早期诊断。

Objective：To study clinical features and imaging findings of thoracic spinal tuberculosis in children in order to provide the evidence for the diagnosis and treatment.Method：Sixty nine children with thoracic spinal tuberculosis admitted into our hospital between July 1997 and July 2007 were studied retrospectively.Of them there were 36 males,33 females,with the mean age of 5.9 years （range,1-14 years ）.Clinical features and imaging findings of these patients were analyzed with statistical methods.Patients were divided into 2 groups according to the stage of spinal cord nerve function,affected segment of vertebra or kyphotic Cobb angle.The number of affected vertebra or paraplegia rate between 2 groups were compared.Result：In these patients,the average disease duration and number of involved vertebra was 15.1 months and 3.2 vertebra respectively.The average kyphotic Cobb angle was 37.5°.Paraplegia occurred in 26 patients （37.7%）.The most common cause leading the patients to the clinics was kyphotic deformity （34.8%）,and the most common symptoms presented in lower extremities（50.7%） including weakness and unstable walking etc.The most common sign was kyphotic deformity（92.8%）.There was significant difference between paraplegia group and normal spinal cord nerve function group in regard to the number of affected vertebra （P〈0.05）.There was significant difference between the upper thoracic vertebral tuberculosis group and middle-lower thoracic vertebral tuberculosis group in regard to the paraplegia rate （84.6% and 26.8%,respectively）（P〈0.05）.There was significant difference between groups of patients with kyphotic angle of no less than 30° and other patients with kyphotic angle of less than 300 in regard to the paraplegia rate （69.8% and 30.4%,respectively）（P〈0.05）.Significant correlations were found among disease duration,number of affected vertebra and kyphotic angle （P〈0.05）.The image of MRI in 35 cases appeared as low or equal intensity signal on T1 weighted images and high or mixed intensity signal on T2 weighted images involving 2 or more adjacent vertebra.The boundary of paraspinal soft tissue was distinct with low intensity signal on T1 weighted images and high or mixed intensity signal on T2 weighted images.The intervertebral disc disappeared or appeared as low intensity signal on T2 weighted images.MRI was better than X-ray and CT scan in terms of showing destruction of intervertebral disc and spinal canal （P〈0.05）.Conclusion：The diagnosis of thoracic spinal tuberculosis of children is easily delayed or misdiagnosed in the early stage.Children with thoracic spinal tuberculosis is prone to develop severe kyphotic deformity.The risk factors of paraplegia include upper thoracic segments, multiple segments and kyphotic deformity of no less than 300.MRI examination can play an important role in early diagnosis of thoracic spinal tuberculosis.