Department of Neurology, Beijing Children's Hospital - 56 Nanlishi Road, Xicheng, Beijing, 100045, China.
Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University - Yifu Science Hall, 37 Xueyuan Road, Haidian, Beijing, 100191, China.
Spine (Phila Pa 1976). 2021 Oct 15;46(20):E1083-E1088. doi: 10.1097/BRS.0000000000004030.
Retrospective study.
To describe the epidemiology and clinical outcomes of pediatric patients with spinal cord injury (SCI) without radiographic abnormality (SCIWORA) in mainland China for the first time.
SCIWORA is a syndrome that often occurs in children mainly due to the unique biomechanics of the pediatric spine. Although there have been numerous retrospective studies on pediatric SCIWORA, and mainland China has more patients with SCI than anywhere else, pediatric patients with SCIWORA in mainland China has not been described in any study.
Review of all cases with SCIWORA at Beijing Children's Hospital between July 2007 and December 2019.
Of the 189 pediatric patients with SCI 140 had SCIWORA (age: 5.65 ± 2.60 years, male-to-female ratio: 2:5). Main causes of injuries were sports (41%, mostly backbend), falls (27%), traffic accidents (10%), and violence (8%). Lesions were located at the thoracic (77%), cervical (10%), multiple (5%), and lumbar (4%) levels. Incubation period was 2 ± 6 hours. Pathological characteristics of SCI were detected in 96% patients by magnetic resonance imaging (MRI). Based on the American Spinal Injury Association impairment scale (AIS), many patients had complete impairment (50% AIS A, 45% AIS B/C/D, 1% AIS E). Particularly, the five patients with normal MRI tended to have mild injury (AIS D) (P < 0.001), but they still showed abnormal reflex. In the one patient who could not be graded at all by AIS, his only functional deficits were abnormal upper and lower limb muscle tones. A total of 59% patients were treated with methylprednisolone, dexamethasone, or both. Out of 76 patients 59 showed neurological improvement before discharge. The only association among age, cause of injury, level of lesion, incubation period, AIS grade, type of corticosteroid therapy, and neurological improvement was between level of lesion and AIS grade (P < 0.001).
Demographic and clinical differences exist in patients with SCIWORA. MRI and detailed neurological examinations should both be performed for proper diagnosis. There is still a need to develop better treatment strategy for these patients.Level of Evidence: 4.
回顾性研究。
首次描述中国大陆无放射学异常的小儿脊髓损伤（SCIWORA）患儿的流行病学和临床结局。
SCIWORA 是一种综合征，主要发生在儿童，这是由于小儿脊柱的独特生物力学特性所致。尽管已经有许多关于小儿 SCIWORA 的回顾性研究，而且中国大陆的 SCI 患者比其他任何地方都多，但在任何研究中都没有描述过中国大陆的小儿 SCIWORA 患者。
对 2007 年 7 月至 2019 年 12 月期间在北京儿童医院收治的所有 SCIWORA 患儿进行回顾性分析。
189 例小儿 SCI 患者中，140 例为 SCIWORA（年龄：5.65±2.60 岁，男女比例：2:5）。主要损伤原因是运动（41%，多为背弯）、跌倒（27%）、交通事故（10%）和暴力（8%）。病变位于胸段（77%）、颈段（10%）、多节段（5%）和腰段（4%）。潜伏期为 2±6 小时。96%的患者通过磁共振成像（MRI）检测到 SCI 的病理特征。根据美国脊髓损伤协会损伤分级（AIS），许多患者完全损伤（50% AIS A、45% AIS B/C/D、1% AIS E）。特别是，5 例 MRI 正常的患者倾向于轻度损伤（AIS D）（P<0.001），但仍表现出反射异常。在无法进行 AIS 分级的 1 例患者中，其唯一的功能缺陷是上下肢肌肉张力异常。共有 59%的患者接受了甲泼尼龙、地塞米松或两者联合治疗。76 例患者中，59 例在出院前出现神经功能改善。年龄、损伤原因、病变水平、潜伏期、AIS 分级、皮质类固醇治疗类型与神经功能改善之间的唯一相关性是病变水平与 AIS 分级之间的相关性（P<0.001）。
SCIWORA 患儿的人口统计学和临床特征存在差异。应进行 MRI 和详细的神经检查以做出正确诊断。对于这些患者，仍需要制定更好的治疗策略。
4 级
