单中心儿童突发性颈部旋转受限420例  

Clinical analysis of acute limited neck motion in 420 children

作　　者：孙祥水[1] 楼跃[1] 范毓华[1] 唐凯[1] 张志群[1] 林刚[1] 周颖[1] 

机构地区：[1]南京医科大学附属南京儿童医院骨科,210008

出　　处：《中华实用儿科临床杂志》2015年第23期1801-1804,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的总结单中心儿童突发性颈部旋转受限的临床特点及鉴别诊断，以提高临床医师的诊治水平。方法回顾性分析2005年1月至2014年1月间南京医科大学附属南京儿童医院收治的420例以突发性颈部旋转受限为首发症状患儿的临床及影像学资料。结果420例患儿中，男248例，女172例；年龄2～14岁，平均7．2岁，病程2h～2d。就诊时均有明显的突发性颈部旋转受限。其中寰枢关节旋转半脱位353例，颈椎髓核钙化42例，多发性抽动7例，颅内占位4例，颈椎嗜酸性肉芽肿3例，颈椎结核2例，良性阵发性斜颈2例，川崎病2例，病毒性脑炎2例，神经母细胞瘤颈椎改变1例，血友病性颈椎脊髓内血肿1例，甲氧氯普胺药物反应1例。353例寰枢关节旋转半脱位患儿影像学主要表现为寰齿间隙不对称或寰枢椎侧块不对称，按Fielding临床分型：Ⅰ型204例，Ⅱ型122例，Ⅲ型21例，Ⅳ型6例。结论儿童突发性颈部旋转受限多数为寰枢关节旋转半脱位，同时应排除其他诊断，以防止误诊误治。突发性颈部旋转受限行枕颌牵引及佩戴颈托固定，疗效可靠。Objective To study the clinical features of acute limited neck motion in children and its differential diagnosis, and to improve doctors＇ awareness and the early diagnosis of the disease. Methods A total of 420 patients with acute limited neck motion as the chief complaint and atlantoaxial rotary subluxatiou as the first diagnosis between January 2005 and January 2014 in Nanjing Children＇s Hospital Affiliated to Nanjing Medical University were enrolled. The clinical manifestations, imaging and consultation data of the 420 patients were retrospectively analyzed. Results There were totally 248 male patients and 172 female patients. The ages ranged from 2 to 14 years old（the mean age was 7.2 years old） ,the course ranged from 2 hours to 2 days. Among 420 patients,353 patients were diagnosed as atlantoaxial rotatory suhluxation. Forty - two patients were diagnosed as cervical intervertebral disc calcification. Seven patients were diagnosed as Tourette syndrome. Four patients were diagnosed as intracranial tumors. Three patients were diagnosed as cervical eosinophilic granuloma. Two patients were diagnosed as cervical spinal tuberculosis. Two patients were diagnosed as viral encephalitis. Two patients were diagnosed as benign paroxysmal torticollis. Two patients were diagnosed as Kawasaki disease. One patient was diagnosed as neuroblastoma. One patient was diagnosed as hemophilia A. One patient was diagnosed as drug adverse reaction of metoclopramide. According to Fielding clinical classification,204 patients were type Ⅰ, 122 patients were type Ⅱ,21 patients were type Ⅲ, and 6 patients were type Ⅳ. Conclusions Based on disease distribution of acute limited neck motion in children, adantoaxial rotatory subluxation seems to be the predominant while non - atlantoaxial rotatory subluxation is not uncommon. Differential diagnoses should be considered to avoid misdiagnosis. For adantoaxial rotatory subluxation, conservative treatment including continuous mandible occipital belt traction and brace has been pr

关 键 词：寰枢关节旋转半脱位 突发性颈部旋转受限 鉴别诊断 儿童 

分 类 号：R726.8[医药卫生—儿科]