Keiper M D, Zimmerman R A, Bilaniuk L T
Department of Radiology, Children's Hospital of Philadelphia, PA 19104, USA.
Neuroradiology. 1998 Jun;40(6):359-63. doi: 10.1007/s002340050599.
We carried out a retrospective analysis of imaging and clinical findings in 52 children with a history of cervical spinal trauma. No patient had evidence of a fracture on plain films or CT. All had MRI at 1.5 T because of persistent or delayed symptoms, unexplained findings of injury or instability, or as further assessment of the extent of soft-tissue injury. Clinical follow-up ranged from 6 months to 3.5 years. MRI was evaluated for its influence on therapy and outcome. MRI was positive in 16 (31%) of 52 patients. Posterior soft-tissue or ligamentous injury was the most common finding in the 10 patients with mild to moderate trauma, while acute disc bulges and longitudinal ligament disruption, each seen in one case, were uncommon. MRI was superior to CT for assessment of the extent of soft-tissue injury and for identification of spinal cord injuries and intracanalicular hemorrhage in the six patients with more severe trauma. MRI specifically influenced the management of all four patients requiring surgery by extending the level of posterior stabilization. No patients with normal MRI or any of the 10 with radiographically stable soft-tissue injury on MRI, developed delayed clinical or radiographic evidence of instability or deformity.
我们对52例有颈椎创伤史的儿童的影像学和临床检查结果进行了回顾性分析。所有患者在X线平片或CT上均无骨折迹象。由于症状持续或延迟、损伤或不稳定的原因不明或为了进一步评估软组织损伤的程度，所有患者均接受了1.5T的MRI检查。临床随访时间为6个月至3.5年。评估MRI对治疗和预后的影响。52例患者中有16例（31%）MRI检查呈阳性。在10例轻度至中度创伤患者中，最常见的发现是后部软组织或韧带损伤，而急性椎间盘突出和纵韧带断裂各1例，较为少见。对于6例创伤较重的患者，MRI在评估软组织损伤程度、识别脊髓损伤和椎管内出血方面优于CT。MRI通过扩大后路稳定范围，对所有4例需要手术的患者的治疗产生了特殊影响。MRI正常的患者或MRI上软组织损伤影像学稳定的10例患者中，均未出现延迟的临床或影像学不稳定或畸形证据。
