The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation.
The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation.
复制标题
颈椎扭伤婴儿综合症：四肢用手摇晃，导致颅内和眼内出血，与残留的永久性脑损伤和智力低下有关。
作者：
J. Caffey
我们的直接和间接证据表明，手动挥鞭式摇晃婴儿是所谓的受虐婴儿综合症中常见的主要创伤类型。这似乎是这些婴儿患有硬膜下血肿和眼内出血的主要原因。在许多情况下，“受虐婴儿”的标签是用词不当，可能会干扰早期诊断和适当的预防性治疗。
婴儿颈椎扭伤性震颤综合征的基本要素呈现出一种非同寻常的诊断矛盾。它们包括颅内和眼内出血，在没有头部外伤或颅骨骨折迹象的情况下，并且与长骨骨膜牵引损伤相关，在没有骨折和四肢上覆皮肤的创伤性变化的情况下。通常没有任何类型的外伤史。
习惯性的、长时间的、偶然的颈部扭伤可能会产生一种隐匿的渐进性临床症状，即潜在的颈部扭伤婴儿综合症，而这种症状通常对父母和医生来说都是不明显的。通常在学龄时首先发现轻微的特发性脑运动缺陷以及轻度特发性精神发育迟滞。当孩子们 5 至 6 岁的时候，也可能第一次发现视力和听力的永久性损伤。从目前的证据来看，此类案件的实际数量无法计算，但似乎数量很大。
颈椎扭伤婴儿综合症这一概念需要对所有单独或合并出现不明原因惊厥、过度烦躁、囟门膨出、瘫痪和剧烈呕吐的婴儿进行仔细的诊断考虑。对所有婴儿的眼底进行常规仔细检查应提供一种优越的筛查方法，以便早期和大量检测致病性颈部扭伤，并在适当情况下对长骨进行放射线检查以进行确认。
目前的证据虽然明显不完整且大多是间接的，但仍需要在全国范围内开展教育活动，以宣传婴儿习惯性、手动、随意的挥鞭式摇晃的潜在致病性，以及婴儿头部习惯性猛拉和摇晃（挥鞭式挥动）的所有其他习惯、做法和程序。
拟议的全国范围内反对摇动、拍打、猛拉和摇动婴儿头部的教育运动总结如下：
好好守护宝宝宝贵的头部，
切勿摇晃、猛拉和拍打它，
免得你伤了他的大脑，扭曲了他的思想，
或者把他永远地鞭打致死。
Our evidence, both direct and circumstantial, indicates that manual whiplash shaking of infants is a common primary type of trauma in the socalled battered infant syndrome. It appears to be the major cause in these infants who suffer from subdural hematomas and intraocular bleedings. The label "battered infant" is a misnomer in many cases which may interfere with early diagnosis and proper preventive treatment.
The essential elements in the infantile whiplash shaking syndrome present an extraordinary diagnostic contradiction. They include intracranial and intraocular hemorrhages, in the absence of signs of external trauma to the head or fractures of the calvaria, and are associated with traction lesions of the periosteums of the long bones in the absence of fractures and traumatic changes in the overlying skin of the extremities. Usually there is no history of trauma of any kind.
Habitual, prolonged, casual whiplash shakings may produce an insidious progressive clinical picture, the latent whiplash shaken infant syndrome, which is often inapparent to both parents and physicians. It usually first becomes evident at school age when minor idiopathic cerebral motor defects are first detected along with mild idiopathic mental retardation. Permanent impairments of vision and hearing may also be identified at this time for the first time when the children are 5 to 6 years of age. The actual number of such cases is incalculable from current evidence but it appears to be substantial.
This concept of the whiplash shaken infant syndrome warrants careful diagnostic consideration in all infants with unexplained convulsions, hyperirritability, bulging fontanel, paralyses, and forceful vomiting singly or in combination. The routine careful examination of the ocular fundi of all infants should provide a superior screening method for early and massive detection of pathogenic whiplash shakings along with radiographic examination of the long bones for confirmation in appropriate cases.
Current evidence, though manifestly incomplete and largely circumstantial, warrants a nationwide educational campaign on the potential pathogenicity of habitual, manual, casual whiplash shaking of infants, and on all other habits, practices and procedures in which the heads of infants are habitually jerked and jolted (whiplashed).
The proposed nationwide educational campaign against the shaking, slapping, jerking, and jolting of infants' heads is summarized in the following stanza:
Guard well your baby's precious head,
Shake, jerk and slap it never,
Lest you bruise his brain and twist his mind,
Or whiplash him dead, forever.