摘要
目的探讨儿童肢体无力的病因及诊治方法。方法收集2008年1月1日至2017年12月31日在西京医院儿科就诊以肢体无力为主要症状收住的89例患儿的临床资料进行回顾性分析。结果在89例患儿中,以神经源性疾病为主(74例,83.15%),前三位病因为颅内感染(27例,30.34%),吉兰-巴雷综合征(20例,22.47%),急性脊髓炎(8例,8.99%)。肌源性疾病2例(2.25%),癔症性瘫痪5例(5.62%),罕见病6例(6.74%),未明确诊断4例(4.49%)。以四肢(47.19%)及双下肢(39.33%)受累为主,临床伴随症状多样化,以神经系统症状为主。在89例患儿中,头颅核磁共振成像(MRI)异常20例(22.47%),脊髓MRI异常13例(14.61%),脑脊液异常46例(51.69%),肌电图提示神经源性病损25例,肌源性病损2例,肌酸激酶显著增高2例。在89例患儿中,5例进行手术治疗,余84例经过内科治疗后痊愈20例,好转61例,3例未愈。结论儿童肢体无力以神经源性疾病为主,四肢及双下肢受累多见,临床表现缺乏特异性,MRI、脑脊液和肌电图等辅助检查对明确病因至关重要。
Objective To investigate the etiology,diagnosis and treatment of limb weakness in children.Methods All 89 children with the complaint of limb weakness admitted to the Department of Pediatrics,Xijing Hospital during the period from January,2008 to December,2017 were enrolled.Medical records information was reviewed retrospectively.Results Among the 89 patients,neurogenic diseases were the main complaints( 74/89,accounting for 83.15%).The top three diseases were intracranial infection(27/89,30.34%),Guillain-Barré syndrome(20/89,22.47%),and acute myelitis(8/89,8.99%).Besides,there were myogenic diseases in 2 cases(2.25%),hysterical paralysis in 5 cases(5.62%) and rare diseases in 6 cases(6.74%).The remaining 4 cases(4.49%) were unknown.The diseases mainly involved limbs(47.19%) and legs(39.33%).The clinical manifestations varied,but neurological symptoms were dominant.Among 89 patients,there were 20 cases(22.47%) with abnormal brain MRI,13 cases(14.61%) with abnormal spinal MRI,46 cases(51.69%)with abnormal cerebrospinal fluid.Electromyogram showed neurogenic lesions in 25 cases and myogenic lesions in 2 cases.Also,there were 2 cases with significantly increased creatine kinase.Among the 89 cases,5 children received neurosurgery operation.The remaining 84 cases were treated with medicines.20 cases were cured at the time of discharge,61 cases were improved,and 3 cases were unchanged.Conclusion Children with limb weakness may be mainly due to neurogenic diseases,and the weakness of limbs and legs is more common.No specificity in clinical manifestations is found.MRI,cerebrospinal fluid examination and electromyography are very important for identifying the underlying cause.
作者
王爱丽
邓跃林
罗建峰
张静静
牛焕红
张月萍
WANG Aili;DENG Yuelin;LUO Jianfeng;ZHANG Jingjing;NIU Huanhong;ZHANG Yueping(Department of Pediatrics.Xijing Hospital of Air Force Military Medical University,Xi'an,710032,Shaanxi,China)
出处
《中国妇幼健康研究》
2019年第10期1275-1280,共6页
Chinese Journal of Woman and Child Health Research
关键词
儿童
肢体无力
病因
诊断
children
limb weakness
cause
diagnosis
