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首页> 外文期刊>The Internet Journal of Spine Surgery >Misdiagnosis of fracture-dislocation of the lumbar spine in a child: technical note.:
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Misdiagnosis of fracture-dislocation of the lumbar spine in a child: technical note.:

机译：小儿腰椎骨折脱位的误诊：技术说明：

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Spinal injuries constitute about one-fiftieth of all injuries in children. About half of these injuries have associated neurological deficits. In children below the age of four years, the diagnosis is made difficult because of communication. The clinician must rely on hearsay to obtain a history. Diagnostic imaging may present difficulties because most Radiologists are not familiar with the anatomy and developmental abnormalities of the spine in young children. This 20-month old child presented with significant other injuries to warrant thorough spinal imaging. Magnetic resonance imaging and computed tomography scan gave conflicting reports. A misdiagnosis of fracture-dislocation of the upper lumbar spine occurred. Repeat investigations should be seriously considered where radiological investigations do not agree with the clinical picture in order to avoid mismanagement. Introduction Spinal injuries are very rare injuries in children. They constitute about 2% - 3% of all injuries in children 1. Fractures are rare in children below the age of eight years, and about 50% present with neurological injuries 2. The lumbar spine is rarely involved 1 About 3% of abused children suffer from spinal injuries, mostly in the cervical spine 3. Diagnostic imaging plays a crucial role in the diagnosis of spinal injuries in children. Ordinary x-rays may not detect subtle injuries because most of children’s bones are made of cartilage. However, it is very crucial that the clinician must interprete the findings within a given clinical context. Advanced imaging like computed tomography scan (ct scan) or magnetic resonance imaging ( mri) may give false images. We report on a case of a misdiagnosed fracture- dislocation of the upper lumbar spine in a 20 month-old child. Case Report A 20 month-old child was run over by a low-velocity minibus taxi. On arrival at the hospital she was in a stable clinical condition. She had no head, neck, chest and abdominal injuries. The pelvis was tender and she had abrasions and a Morel-Lavallee lesion involving the posterior aspect of the pelvis and the whole lumbar spine. The whole lumbar region was clinically tender. Per vaginum and rectal examinations revealed blood. She had a normal rectal tone. She had slight movements of the knees and ankles. Full neurological examination could not be done due to communication problems. X-rays of the pelvis showed disruption of the symphysis pubis, fracture of the left ilium plus disruption of the ipsilateral sacro-iliac joint. The thoraco-lumbar spine was poorly visualized, but appeared normal ( figure 1)
机译：脊柱受伤约占儿童所有伤害的五十分之一。这些伤害中约有一半伴有神经功能缺损。在四岁以下的儿童中，由于沟通困难，难以进行诊断。临床医生必须依靠传闻证据获得病史。诊断成像可能会遇到困难，因为大多数放射科医生不熟悉幼儿脊柱的解剖结构和发育异常。这个20个月大的孩子还受到其他重大伤害，需要进行全面的脊柱成像。磁共振成像和计算机断层扫描显示了相互矛盾的报道。发生了上腰椎骨折脱位的误诊。如果放射线检查与临床情况不符，应认真考虑重复检查，以免管理不当。简介脊髓损伤是儿童中非常罕见的损伤。它们约占儿童所有伤害的2％-3％。1岁以下的儿童很少发生骨折，约有50％的儿童患有神经系统损伤2。腰椎很少受累1约3％的受虐待儿童脊柱损伤多发于颈椎3。诊断成像在诊断儿童脊柱损伤中起着至关重要的作用。普通的X射线可能无法检测到细微的伤害，因为大多数儿童的骨头都是由软骨制成的。但是，临床医生必须在给定的临床背景下解释这些发现非常关键。诸如计算机断层扫描（ct扫描）或磁共振成像（mri）之类的高级成像可能会产生虚假图像。我们报告了一名20个月大儿童上腰椎骨折错位的误诊病例。病例报告一名20个月大的儿童被一辆低速小巴出租车撞倒。到达医院后，她的病情稳定。她没有头部，颈部，胸部和腹部受伤。骨盆触痛，擦伤，并累及骨盆后侧和整个腰椎的Morel-Lavallee病灶。整个腰椎区域临床柔软。每次阴道和直肠检查均显示有血液。她的直肠音正常。她的膝盖和脚踝轻微运动。由于沟通问题，无法进行全面的神经系统检查。骨盆的X射线检查显示耻骨联合破裂，左i骨骨折以及同侧-关节破裂。胸腰椎的可视化较差，但看起来正常（图1）

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