重新定义儿科SCIWORA:对临床模式,成像资料和管理见解的文献进行系统审查
Davide Palombi1,2, Marco Galeazzi1,2, Paolo Brigato3,4
1Department of Pediatric Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
没有放射性异常的儿科脊髓损伤 (SCIWORA) 结果取决于MRI发现和最初的神经状况. 大多数儿童通过保守治疗得到改善,但对于特定的MRI阳性病变可能需要手术.
科学领域:
- 儿科神经学 儿科神经学
- 神经外科 神经外科
- 放射学 放射学是一门学科.
背景情况:
- 没有放射性异常的脊髓损伤 (SCIWORA) 由于其异质性,提出了诊断和治疗方面的挑战.
- 虽然大多数儿科SCIWORA病例通过保守的管理得到解决,但有些需要基于成像的外科干预.
- 需要标准化标准和基于证据的算法,以获得一致的护理和更好的结果.
研究的目的:
- 为了澄清对儿科SCIWORA的理解.
- 为了区分"真正的"SCIWORA和类似SCIWORA的情况.
- 综合当前关于流行病学,机制,呈现,MRI发现和管理的证据.
主要方法:
- 在PubMed,Cochrane,Scopus和Embase数据库中的系统文献搜索.
- 包括关于儿科SCIWORA (18岁以下) 的研究,报告人口统计,临床,放射性特征,管理和结果.
- 遵守PRISMA指导方针进行研究选择.
主要成果:
- 84%的儿科患者 (n=848) 来自60项研究;平均年龄9.33岁,男性占主导地位.
- 核磁共振扫描显示了脑内神经病变 (46%),没有异常 (39%),结合病变 (9%) 或脑外神经异常 (6%).
- 大多数患者呈现ASIA A (46.25%),但在随访时49.78%的患者实现了ASIA E;66.2%的神经状况改善. 保守治疗 (95.41%) 是主要的;手术 (4.59%) 是因为不稳定或压缩.
结论:
- 儿科SCIWORA不常见但严重,结果与MRI发现和初始神经状态有关.
- 磁力共振成像分类有助于理解损伤模式和指导治疗.
- 进一步的研究应该集中在标准化诊断标准和治疗算法为儿科SCIWORA.
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