《中国康复理论与实践》

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (4): 456-465.doi: 10.3969/j.issn.1006-9771.2021.04.011

• 临床观察 • 上一篇    下一篇

儿童下腰后脊髓损伤的临床表现及MRI特点

刘根林1,2,周红俊1,2(),李建军1,3,卫波1,2,王一吉1,2,张缨1,2,蒙倩茹1,2,郑樱1,2,郝春霞1,2,康海琼1,2,逯晓蕾1,2,袁媛1,2   

  1. 1.首都医科大学康复医学院，北京市 100068
    2.中国康复研究中心北京博爱医院，北京市 100068
    3.中国康复科学所，北京市 100068
  • 收稿日期:2021-01-07 修回日期:2021-01-25 出版日期:2021-04-25 发布日期:2021-04-20
  • 通讯作者: 周红俊 E-mail:zh87569303@qq.com
  • 作者简介:刘根林(1965-)，男，汉族，浙江义乌市人，博士，主任医师，主要研究方向：脊髓损伤康复。
  • 基金资助:
    中国康复研究中心课题(2019ZX-18);北京市丰台区卫生健康系统科研课题(2019-111)

Clinical Manifestations and MRI Features of Pediatric Spinal Cord Injury after Back Bend

Gen-lin LIU1,2,Hong-jun ZHOU1,2(),Jian-jun LI1,3,Bo WEI1,2,Yi-ji WANG1,2,Ying ZHANG1,2,Qian-ru MENG1,2,Ying ZHENG1,2,Chun-xia HAO1,2,Hai-qiong KANG1,2,Xiao-lei LU1,2,Yuan YUAN1,2   

  1. 1.Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
    2.Beijing Bo'ai Hospital, China Rehabilitation Research Centre, Beijing 100068, China
    3.China Institute of Rehabilitation Science, Beijing 100068, China
  • Received:2021-01-07 Revised:2021-01-25 Published:2021-04-25 Online:2021-04-20
  • Contact: Hong-jun ZHOU E-mail:zh87569303@qq.com
  • Supported by:
    China Rehabilitation Research Centre Research Project(2019ZX-18);Health System Research Project, Fengtai District, Beijing(2019-111)

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摘要： 目的

探讨儿童下腰后脊髓损伤的临床表现及MRI特点。

方法

对2002年1月1日至2020年8月31日北京博爱医院收治的下腰后脊髓损伤儿童的住院病历及MRI检查结果进行回顾性分析。

结果

下腰后脊髓损伤儿童共120例，其中女童119例，男童1例；年龄38~162个月，中位数76个月；每年7月和9月发病人数较多(32例，26.7%)，周末发病人数较多(67例，55.8%)。临床主要表现为双下肢感觉运动障碍和大小便障碍(120例，100%)。常见首发症状：突发腰疼(39例，32.5%)、下肢无力(30例，25.0%)和腿疼(10例，8.3%)。症状达顶峰时间5 min~2 d，中位数50 min。104例下腰后脊髓损伤儿童1周内MRI特点：脊髓信号异常涉及下颈段及其以下的所有脊髓节段，信号异常的节段数量2~15个，中位数7个。常见信号异常节段为：T9 96例(92.3%)、T10 96例(92.3%)、T11 90例(86.5%)。随访48例完全性脊髓损伤儿童MRI特点：伤后最早37 d即开始出现损伤节段以下至圆锥的广泛脊髓萎缩，随病程延长萎缩逐步加重，并可出现损伤节段以上的脊髓萎缩；随访31例不完全性SCI儿童的MRI，可见脊髓腰膨大局灶性脊髓信号异常，随病程延长出现脊髓腰膨大不同程度萎缩。所有病例均诊断为无骨折脱位型脊髓损伤，其中完全性胸段脊髓损伤89例(74.2%)，不完全性胸、腰段脊髓损伤31例(25.8%)。常见并发症：脊柱侧弯、髋关节发育异常、泌尿系感染、肾积水、骨质疏松、下肢病理性骨折和膝外翻。

结论

下腰后儿童脊髓损伤临床主要表现为突发腰疼、双下肢感觉运动障碍和大小便障碍。大多数病例为胸段完全性脊髓损伤，MRI特点为早期出现以T9、T10为中心的多节段脊髓信号异常，晚期出现损伤节段以下至圆锥的广泛脊髓明显萎缩，可伴有损伤节段以上脊髓萎缩。

关键词: 下腰, 儿童, 脊髓损伤, 症状, 磁共振成像

Abstract: Objective

To explore the clinical manifestations and MRI features of pediatric spinal cord injury (SCI) after back bend.

Methods

A retrospective study was performed. All the medical records and MRI images of children with SCI after back bend were identified in Beijing Bo'ai Hospital from January 1st, 2002 to August 31st, 2020.

Results

A total of 120 SCI children after back bend were reviewed, out of whom 119 cases were girls, one case was boy. The age ranged from 38 to 162 months, with the median age of 76 months. More cases were discovered in July and September every year (32 cases, 26.7%), as well as in weekends (67 cases, 55.8%). The main clinical manifestations were sensory and motor dysfunction of both lower limbs (120 cases, 100%), bladder and bowl incontinence (120 cases, 100%). The common first symptoms included sudden attack of lumbar pain (39 cases, 32.5%), lower limbs paralysis (30cases, 25.0%) and leg pain (10 cases, 8.3%). The peak time of symptoms ranged from five minutes to two days, with the median time of 50 minutes. The MRI features of 104 children with SCI within one week after back bend were as follows: the abnormal signals of MRI in spinal cord involved lower cervical and all the following segments of spinal cord. The number of the segments of spinal cord with abnormal signals ranged from two to 15, with the median of seven segments. The most common segments with abnormal signals were T9 (96 cases, 92.3%), T10 (96 cases, 92.3%) and T11 (90 cases, 86.5%). Among the cases followed up, 48 cases with complete injury demonstrated a vast and serous spinal cord atrophy (SCA) below the injury segments as early as 37 days after the injury, the SCA would become worse at the chronic stage and maybe involve the spinal cord above the injury segments. In 31 cases with incomplete injury, the abnormal signals of MRI in spinal cord were limited in the lumbar enlargement, with a various degree of SCA at the late stage. All the cases were diagnosed as SCI without radiologic abnormality, out of whom 89 (74.2%) cases suffered from thoracic complete SCI, 31 (25.8%) cases suffered thoracic or lumbar incomplete SCI. The common complications included scoliosis, hip joint dysplasia, urinary tract infection, hydronephrosis, osteoporosis, pathological fracture of lower limbs and valgus knee.

Conclusion

The main clinical symptoms of pediatric SCI after back bend were sudden lumbar pain, sensory and motor dysfunction of both lower limbs, and bladder and bowl incontinence. Most of the cases were thoracic complete SCI, the MRI features at the early stage were multiple segments of abnormal signals of spinal cord around T9 and T10, and later an extensive severe SCA below the injury segments to the conus medullaris, accompanied by the SCA above the injury segments.

Key words: back bend, children, spinal cord injury, symptom, magnetic resonance imaging

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