儿童严重寰枢椎旋转性半脱位的诊断与治疗  

Management of Severe Atlantoaxial Rotatory Subluxation in Children

作　　者：张学军[1] 张质彬[1] 杨建平[1] 

机构地区：[1]天津医院小儿骨科,300211

出　　处：《中华小儿外科杂志》1999年第4期202-204,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的　总结儿童严重寰枢椎旋转性半脱位的特点及诊治体会。方法　1982 ～1992 年收治7 例Fielding 和Hawkins 分型中的Ⅲ型病例, 平均年龄为8 .5 岁, 男孩5 例, 女孩2 例。平均确诊时间7.8周, 无一例出现神经系统症状、体征。经颌枕布袋牵引, 在6 周内5 例临床及X 线效果满意, 继续颈托固定2～3 个月。2 例牵引10 周,X 线片显示C1 、C2 关系仍未恢复正常,1 例行枕～C2后路融合术,1 例拒绝手术。平均随访时间8.1 年(5 ～16 年)。结果　除拒绝手术的1 例时有复发外, 其余6 例无任何自觉症状, 颈部活动正常,X 线片显示齿状突与侧块距离相等, 颈椎生理弧度恢复,寰椎前结节后缘与齿状突前缘距离在2 m m 以内。结论　①临床表现轻, 一般无神经系统症状、体征, 易误诊或漏诊是本病的特点; ②早期诊断是治疗的关键; ③保守治疗6Objective To review the experience in managing severe atlantoaxial rotatory subluxation in children. Methods Between 1982 and 1992, 7 children with Fielding and Hawkins classification type Ⅲ atlantoaxial rotatory subluxation were admitted. The mean age was 8.5 years. There were 5 boys and 2 girls. None had any neurological sign or symptom. Five children were treated with traction for 6 weeks, followed by collar support for another 2 to 3 months. The recovery was satisfactory with no residual clinical or radiological abnormality. Two patients had persistent radiological deformity after 10 weeks of traction. One patient underwent occipitoaxial arthrodesis whereas the other one refused operation. The mean follow up time was 8.1 years (range: 5 16 years). Results The patient who refused operation had recurrence of subluxation. The remaining 6 patients have recovered well and asymptomatic with no radiological abnorma lity. Conclusions The clinical sign and symptom of atlantoaxial rotatory subluxation are not obvious. Early diagnosis is crucial. Arthrodesis is indicated if traction failed to achieve reduction within 6 weeks.

关 键 词：颈椎 寰枢椎旋 转性半脱位 儿童 诊断 治疗 

分 类 号：R726.821.3[医药卫生—儿科]