Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham University Hospitals, West Block D Floor, Derby Road, Nottingham, NG7 2UH, UK.
Eur Spine J. 2012 Nov;21(11):2205-11. doi: 10.1007/s00586-012-2292-1. Epub 2012 Jun 26.
This grand rounds is about the clinical and radiological presentation, treatment and outcome of pediatric cervical spine injury. A 15-month-old girl suffers from a motor vehicle accident and is intubated on-site because of progressive agitation. Whole body trauma CT was read as normal. When sedation was discontinued after 24 h she was found to be tetraplegic below C6 level. MRI shows a total disruption between C6 and C7 that in hindsight was also visible on the initial trauma CT. She was treated surgically by an anterior and posterior reconstruction and was post-operatively treated with a halo vest. Clearing the cervical spine in young children is deceptively difficult. Meticulous review and interpretation of conventional radiographs and CT are important yet MRI should be considered in uncertain cases. Severe ligamentous injury without concomitant bony injury occurs more frequently than in older children and adults, with sometimes devastating consequences.
本次大查房介绍了儿童颈椎损伤的临床和影像学表现、治疗方法和转归。一名 15 个月大的女孩因车祸被现场插管，因为她的病情逐渐恶化。全身创伤 CT 检查未见异常。24 小时后镇静剂停止使用后，发现她的 C6 以下部位出现四肢瘫痪。MRI 显示 C6 和 C7 之间完全断裂，回想起来，在最初的创伤 CT 上也能看到。她接受了前后重建的手术治疗，术后使用了 halo 背心。在儿童中清除颈椎看似很简单，但实际上极具欺骗性。仔细审查和解释常规 X 线和 CT 非常重要，但在不确定的情况下应考虑进行 MRI。与大龄儿童和成人相比，儿童颈椎损伤更常出现无伴发骨折的严重韧带损伤，且后果通常较为严重。
