后路钉板固定融合治疗儿童寰枢椎不稳定及脱位的疗效分析  

Posterior screw-plate system fixation and fusion atlantoaxial instability and dislocation in children

作　　者：刘虎[1] 郭东[1] 张学军[1] 姚子明 Liu Hu;Guo Dong;Zhang Xuejun;Yao Ziming(Department of Orthopedics,Affiliated Children's Hospital&National Children's Medical Center,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院骨科,北京100045

出　　处：《临床小儿外科杂志》2023年第11期1029-1033,共5页Journal of Clinical Pediatric Surgery

基　　金：中央高水平医院临床科研业务费资助(2022-PUMCH-D-004)

摘　　要：目的初步探讨后路寰枢椎螺钉钢板固定、自体植骨融合治疗儿童寰枢椎不稳定及脱位的疗效。方法本研究为回顾性研究,以2019年3月至2022年6月在首都医科大学附属北京儿童医院骨科接受后路寰枢椎钉板固定治疗的22例寰枢椎不稳定及脱位患儿为研究对象。男12例,女10例;年龄(8.2±2.8)岁。采用美国脊髓损伤协会(American Spinal Injury Association,ASIA)神经系统分级评估手术前后脊髓损伤程度及改善情况。测量寰齿前间隙(atlanto-dens interval,ADI)、斜坡枢椎角(clivus-axial angle,CAA),评估寰枢椎复位情况;记录脊髓有效空间(space available for spinal cord,SAC),评估脊髓压迫情况;记录植骨融合以及并发症发生情况。结果22例均获随访,随访时间(45.8±14.5)个月。20例行一期后路寰枢椎钉板固定术,2例经口松解后再行后路复位融合术;22例患儿术中无一例脊髓或椎动脉损伤。术后及末次随访时的ADI分别为(2.6±1.3)mm、(2.7±1.0)mm,CAA分别为(143.1±6.4)°、(142.7±8.5)°,SAC分别为(18.7±3.4)mm、(18.9±3.0)mm;与术前ADI[(9.0±3.2)mm]、CAA[(120.5±13.1)°]、SAC[(13.6±5.2)mm]相比较,差异均有统计学意义(P<0.017)。末次随访时,术前有神经症状的13例患儿ASIA分级均达到E级,所有患儿颈椎CT重建可见骨性融合良好,寰枢椎均达到解剖复位,无一例内固定松动及断裂。结论采用后路寰枢椎钉板固定、自体髂骨松质骨植骨融合治疗儿童寰枢椎不稳定及脱位,可使寰枢椎获得解剖复位及良好固定,并可获得较理想的植骨融合效果。Objective To evaluate the efficacy of posterior atlantoaxial screw-plate fixation and autologous bone graft fusion for atlantoaxial instability and dislocation in children.Methods From March 2019 to October 2022,22 children with atlantoaxial instability and dislocation were retrospectively reviewed.There were 12 boys and 10 girls with an age range of(8.2±2.8)(4-14)year.Degree and improvement of spinal cord injury before and after surgery were assessed by the neurological grading system of American Spinal Cord Injury Association(ASIA).Atlantodens interval(ADI)and clivus-axial angle(CAA)were measured for evaluating the reduction of atlas and axis.Space available for spinal cord(SAC)was measured for evaluating spinal cord compression.And ASIA impairment scale,bone graft fusion and complications were recorded.Results One-stage posterior atlantoaxial screw-plate fixation(n=20)and posterior reduction plus fusion after anterior release(n=2)were performed.The average follow-up period was(45.8±14.5)(13-48)month.No intraoperative injury of spinal cord or vertebral artery occurred.The postoperative and final follow-up ADI(2.6±1.3),(2.7±1.0)mm,CAA(143.1±6.4),(142.7±8.5)and SAC(18.7±3.4),(18.9±3.0)mm were compared with preoperative ADI[(9.0±3.2)mm],CAA[(120.5±13.1)]and SAC[(13.6±5.2)mm].And the differences were statistically significant(P<0.05).At the last follow-up,13 children with preoperative neurological symptoms attained ASIA grade E.And solid fusion and anatomical reduction were obtained on cervical CT scan without any loosening or fracturing of internal fixation.Conclusions For atlantoaxial instability and dislocation in children,posterior atlantoaxial screw-plate system fixation and autologous iliac cancellous bone graft fusion may achieve anatomical reduction and strong fixation and yield excellent outcomes of bone graft fusion.

关 键 词：寰枢关节 脱位 先天畸形 外科手术 儿童 

分 类 号：R726.8[医药卫生—儿科]