儿童齿状突骨折的诊治探讨  

Diagnosis and treatment of odontoid fracture in children

作　　者：陈建松[1] 吴伟良[1] 朱建[1] 舒强[2] 

机构地区：[1]浙江大学医学院附属儿童医院骨科,杭州310003 [2]浙江大学医学院附属儿童医院胸外科,杭州310003

出　　处：《中华小儿外科杂志》2015年第5期350-353,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨儿童齿状突骨折的临床特点及治疗策略。方法回顾性分析我院收治的7例齿状突骨折患儿，其中男5例，女2例；年龄3～12岁，平均5．6岁。致伤原因：2例为车祸伤，5例为高处坠落伤。根据Anderson-D’Alonzo分型，均为Ⅱ型骨折（5例为骨骺分离，2例为真性骨折）．2例患儿合并脊髓损伤，其中1例单侧肢体麻痹，另1例高位截瘫。5例患儿行Minerva石膏技术治疗，1例大龄儿童行颈后路寰枢椎螺钉固定融合术，另1例合并肢体麻痹者行颈后路寰枢椎临时固定术。结果高位截瘫患儿行Minerva石膏固定后，齿状突复位良好，但因肺部严重感染于伤后1个月死亡。余6例患儿均获随访，随访时间7～84个月（平均34个月），均达骨性愈合，愈合时间为2～4个月（平均2．6个月）。Minerva石膏治疗的4例患儿颈部伸屈及旋转活动均正常，其中2例出现腋窝皮肤压疮。手术治疗的2例患儿，行寰枢椎融合术者，颈部左、右旋转仅30°，行寰枢椎临时固定者，颈部左右旋转约65°，该患儿于术后3个月神经功能完全恢复。结论儿童齿状突骨折常表现为齿状突骨骺分离。复位及Minerva石膏固定是一种方便、有效的方法，可作为儿童齿状突骨折的首选治疗方法，后路内固定易引起颈部活动障碍，仅适用于少部分患儿，骨折愈合后需及时拆除内固定。Objective To explore the clinical characteristics and treatment strategies of odontoid fractures in children. Methods A total of 7 pediatric patients with odontoid fractures were analyzed retrospectively. There were 5 males and 2 females with an average age of 5.6 （3-12） years. The causes were traffic accident （n = 2） and fall （n = 5）. All of them belonged to type II fracture according to the Anderson-Oalonzo classification. And the factures were synchondrosis （n = 5） and real （n = 2）. Two patients had neurologic involvements of unilateral extremity paresthesia （n = 1 ） and high paraplegia （n = 1）. Five patients underwent closed reduction and Minerva cast immobilization. One senior boy had atlantoaxial fixation and fusion paresthesia temporary atlantoaxial fixation. Results while another patient with unilateral extremity reduction after Minerva cast immobilization, but died The patient with high paraplegia achieved fair 1 month later from severe pulmonary infection. The reminder was followed up for a median period of 34（7-84） months. Complete fracture union was achieved. The median healing time was 2. 6 （2-4） months. Four patients with Minerva cast immobilization regained excellent cervical motion. The cervical rotation was merely 30 for patients of atlantoaxial fixation and fusion and 65 for those of temporary atlantoaxial fixation. The patient with unilateral extremity paresthesia achieved complete neurologic recovery at 3 months post-operation. Conclusions Most odontoid fractures in children are synehondrosis type, Closed reduction and Minerva cast immobilization is an effective first option for pediatric odontoid fractures. Open reduction and atlantoaxial fixation results in cervical rotation limitation. And it may be used for some select patients. Internal fixation should removed after fracture union.

关 键 词：齿状突 骨折 颈椎 儿童 

分 类 号：R726.8[医药卫生—儿科]