小儿颈椎及颈脊髓损伤

Pediatric Cervical Spine and Spinal Cord Injuries

目的 总结小儿颈椎及颈脊髓损伤的诊断治疗经验。方法 回顾分析４７ 例小儿颈椎及颈脊髓损伤， 男３１ 例， 女１６ 例， 年龄６ ～１４ 岁， 平均１１ ．６ 岁。新鲜损伤１９ 例， 陈旧性损伤２８ 例。其中上颈椎损伤３３ 例， 下颈椎损伤１０ 例， 多节段间隔性颈椎损伤１ 例， 无Ｘ线异常的脊髓损伤３ 例。非手术治疗２７ 例， 手术治疗１９ 例， 未治１ 例。结果 早期死亡１ 例。４５ 例获１ ～１２ 年随访， 恢复正常或接近正常者３４ 例， 明显改善者６ 例，５ 例无改善。结论 影像学检查对于小儿颈椎及颈脊髓损伤的诊断具有重要价值， 小儿颈椎损伤多数不需手术治疗，不稳定性损伤非手术治疗无法复位并保持稳定或脊髓损害加重者应考虑手术治疗。

Objective This study is designed to provide the experience in diagnosis and treatment of cervical spine and spinal cord injuries in children. Methods Forty seven children with cervical spine and spinal cord injuries were retrospectively reviewed. There were 31 males and 16 females, with their age ranging 6 to 14 years (mean, 11.6 years). Nineteen children had fresh injuries, whereas the remaining 28 sustained old injuries. Of these patients, thirty one patients were identified with injuries of upper cervical spine, 10 were with injuries of lower cervical spine, 1 was with multiple noncontiguous injuries of cervical spine, and 3 were with spinal cord injuries without radiographic abnormalities. All these patients underwent nonoperative (27 cases) or operative (19 cases) treatment except one who refuse treatment. Results A follow up for 1 to 12 years showed that 34 patients had complete or significant improvement, six had moderate improvement and 5 remained unchanged. Conclusions Imaging assessment is of great importance to diagnosis and treatment of cervical spine and spinal cord injuries in children. Most injuries do not require surgical intervention, but decompression and/or fusion should be indicated in those patients with unstable injuries that cannot be reduced and stablilized by conservative therapy or progressive neurological deficit.