Magerl技术治疗儿童寰枢关节旋转半脱位  

Magerl technique for children atlantoaxial rotatory subluxation

作　　者：唐明星[1] 张宏其[1] 刘金洋[1] 王昱翔[1] 郭超峰[1] 刘少华[1] 邓盎[1] 高琪乐[1] 王龙杰[1] 郭强[1] 

机构地区：[1]中南大学湘雅医院脊柱外科,湘雅脊柱外科中心,长沙410008

出　　处：《中华骨科杂志》2016年第9期570-576,共7页Chinese Journal of Orthopaedics

基　　金：湖南省芙蓉学者项目

摘　　要：目的探讨Magerl技术治疗儿童寰枢关节旋转半脱位的可行性及其疗效。方法2004年12月至2014年9月收治儿童寰枢关节旋转半脱位患者63例，其中16例行后路经寰枢椎侧块关节UCSS空心螺钉固定（Magerl技术）、植骨融合术，男9例，女7例；年龄8-14岁，平均（11±2．3）岁。寰枢关节旋转脱位按Fielding分型：Ⅱ型10例，Ⅲ型6例。其中1例（6．3％）单纯表现为头晕，11例（68．8％）存在斜颈畸形；14例（87．5％）出现枕颈部疼痛；1例患者（6．3％）存在高位脊髓压迫症状。所有患者术前均行颅骨牵引，再行Magerl技术固定融合寰枢椎。采用寰枢椎张口位、颈椎侧位x线片及寰枢椎三维cT评估螺钉位置和植骨融合情况。临床疗效评价采用Symon和Lavender临床功能评定标准，影像学评价采用寰齿前间隙（atlas．densinterval，ADI）和脊髓有效空间（spaceavailableforthecord，SAC）。结果所有患者术中均顺利完成双侧UCSS螺钉固定，未发生神经、血管损伤等并发症。术后患者症状明显改善，无神经症状加重表现，影像学检查证实UCSS螺钉均通过寰枢椎侧块关节，所有置入螺钉位置准确，无寰枕关节活动受限。随访时间3—98个月，平均（38±14．6）个月。骨性融合时间为术后3-6个月。末次随访时临床功能改善率为93．8％。术后SAC较术前平均增加（6．06±1．29）mm，差异有统计学意义；末次随访时为（15．31±0．79）mm，与术后比较差异无统计学意义。术后ADI较术前平均减少（5．75±1．53）mm，差异有统计学意义；末次随访时ADI为（1．94±0．57）mm，与术后比较未见明显丢失。结论术前颅环弓牵引结合Magerl技术治疗儿童寰枢关节旋转半脱位是安全、有效的方法。Objective To discuss the feasibility and prognosis of magerl technique for children. Atlantoaxial Rotatory Subluxation. Methods 63 patients with Atlantoaxial Rotatory Subluxation were treated in our hospital, and 16 of whom were treated with bilateral C1.2 posterior transarticular screw fixation and fusion. All cases aged from 8 to 14, with an average age of 11 ±2.3 years old. According to Fielding classification, 10 cases were in type II, and 6 in type III. 1 patient showed dizziness, 11 patients showed obvious appearance of deviation of head and neck; 14 patients showed varying degrees of occipito-cervical pain, and one patient showed incomplete paralysis. All patients had undergone Halo traction, then the Magerl surgery for atlantoaxial fixation fu- sion. Through follow-up and photograph of atlantoaxial mouth opening, lateral cervical X-ray and atlantoaxial 3D CT, the screw po- sition and bone graft fusion were evaluated. The clinical and radiological outcomes were evaluated according to the Symon and Lav- ender clinical standard, the imaging index space available for the cord （SAC）, and the atlas-dens interval （ADI）. Results All cas- es were followed up for 3 to 98 months （mean 38±14.6 months）. All patients had completed the bilateral UCSS screw fixation, and the symptoms were improved significantly, without neurological symptoms aggravated or complications such as neurovascular inju- ry. All UCSS screw position through the atlantoaxial joint was accurate, without atlanto occipital joint activity limitation. All pa- tients got bony fusion 3 to 6 months post-operation. The clinical recovery rate was 93.8%. The SAC of C1,2 segment increased by 6.06± 1.29 mm postoperatively, which showed a significant difference compared with preoperative SAC. The SAC at the latest fol- low-up was 15.31 ±0.79 mm, showing no significant difference compared with that just postoperatively. The ADI at one month post- operatively decreased by 5.75±1.53 ram, showing a significant difference compared with preoperative

关 键 词：寰枢关节 脱位 儿童 内固定器 脊柱融合术 

分 类 号：R726.8[医药卫生—儿科]