Diamond P, Hansen C M, Christofersen M R
Pediatric Practices of Northeast Pennsylvania, Honesdale.
Pediatr Emerg Care. 1994 Apr;10(2):83-6. doi: 10.1097/00006565-199404000-00005.
A child sustained a traumatic thoracolumbar spinal fracture--dislocation with cord compression. A court confirmed the diagnosis of child abuse. There was no history of trauma, and the diagnosis of child abuse was missed by the physicians who first saw the child. Spinal injuries in child abuse are uncommon. They may be symptomatic or asymptomatic, stable or unstable, or occur with or without bony changes on the x-rays. Injuries without a history of trauma may be overlooked if asymptomatic. Radiologic skeletal surveys in suspected abuse should include a minimum of two views of the spine even if the child has no symptoms referrable to the spine. Conversely, a traumatic cause should be considered whenever there is spinal cord injury without vertebral injury. Having a high index of suspicion for abuse while remembering that pediatric spinal injuries may occur in the context of normal x-rays will decrease the likelihood of missed diagnosis, repeated abuse, or complications from delayed immobilization of unstable injuries.
一名儿童遭受了创伤性胸腰椎脊柱骨折脱位并伴有脊髓受压。法院证实这是一起虐待儿童的诊断。该儿童没有外伤史，最初接诊的医生漏诊了虐待儿童的诊断。虐待儿童导致的脊柱损伤并不常见。它们可能有症状或无症状，稳定或不稳定，X线片上可能有或没有骨质改变。如果无症状，没有外伤史的损伤可能会被忽视。对于疑似虐待的情况，放射学骨骼检查至少应包括脊柱的两个视图，即使儿童没有脊柱相关症状。相反，每当出现脊髓损伤而无椎体损伤时，都应考虑外伤原因。在高度怀疑虐待的同时，记住小儿脊柱损伤可能在X线片正常的情况下发生，这将降低漏诊、再次虐待或不稳定损伤延迟固定导致并发症的可能性。
