Vogel Lawrence C, Betz Randall R, Mulcahey M J
Shriners Hospitals for Children, Chicago, IL, USA.
Handb Clin Neurol. 2012;109:131-48. doi: 10.1016/B978-0-444-52137-8.00008-5.
This chapter provides an overview of spinal cord injuries (SCI) in children and adolescents, including epidemiology, medical and musculoskeletal complications, rehabilitation and psychosocial aspects. Males are more commonly affected than females during adolescence; however, as the age at injury decreases, the preponderance of males becomes less marked, and by 3 years of age the number of females with SCIs equals that of males. The neurologic level and degree of completeness varies with age; among children injured prior to 12 years of age approximately two-thirds are paraplegic and approximately two-thirds have complete lesions. Among adolescents, approximately 50% have paraplegia and 55% have complete lesions. Management of pediatric-onset SCI should be family centered and developmentally based, responsive to the dynamic changes that occur during growth and development. Distinctive anatomical and physiological features of children and adolescents, along with growth and development, are responsible for unique manifestations and complications of pediatric SCI. SCI without radiological abnormalities (SCIWORA), birth injuries, lap-belt injuries, upper cervical injuries, and the delayed onset of neurological deficits are relatively unique to pediatric SCI. Children who sustain their SCI before puberty experience a higher incidence of musculoskeletal complications, such as scoliosis and hip dislocation.
本章概述了儿童和青少年脊髓损伤（SCI），包括流行病学、医学和肌肉骨骼并发症、康复及心理社会方面。在青春期，男性比女性更易受影响；然而，随着受伤年龄的降低，男性的优势变得不那么明显，到3岁时，脊髓损伤女性的数量与男性相等。神经损伤平面和损伤的完全程度随年龄而异；在12岁之前受伤的儿童中，约三分之二为截瘫，约三分之二有完全性损伤。在青少年中，约50%为截瘫，55%有完全性损伤。儿童期脊髓损伤的管理应以家庭为中心，并基于发育情况，以应对生长发育过程中发生的动态变化。儿童和青少年独特的解剖和生理特征，以及生长发育，导致了儿童脊髓损伤的独特表现和并发症。无放射学异常的脊髓损伤（SCIWORA）、产伤、安全带损伤、上颈椎损伤以及神经功能缺损的延迟出现是儿童脊髓损伤相对特有的情况。在青春期前发生脊髓损伤的儿童出现肌肉骨骼并发症（如脊柱侧弯和髋关节脱位）的发生率较高。
