合并脊髓损伤的难治性儿童齿状突骨折合并寰枢椎脱位的手术疗效分析  

Surgical treatment of intractable odontoid fracture with atlantoaxial dislocation in children with spinal cord injury

作　　者：梁卫东[1] 任周梁 盛军[1] 王健[1] 牙克甫·阿不力孜 盛伟斌[1] 

机构地区：[1]新疆医科大学第一附属医院脊柱外科,830054

出　　处：《中华医学杂志》2018年第8期587-591,共5页National Medical Journal of China

摘　　要：目的评价合并脊髓损伤的难治性儿童齿状突骨折合并寰枢椎脱位的手术治疗方法及临床疗效。方法收集新疆医科大学第一附属医院脊柱外科2010年1月至2014年12月收治的14岁以下、合并脊髓损伤的难治性儿童齿状突骨折合并寰枢椎脱位患者10例，受伤至入院时间1～30 d，平均8.5 d，手术采取一期后路复位钉棒固定或前路松解联合后路复位钉棒固定技术。回顾性分析患儿术前、术后神经功能改善情况以及骨折脱位复位、植骨融合情况。结果术后随访12～48个月，平均22个月。末次随访X线片及CT示骨折脱位均复位良好、植骨融合，无内固定松动或断裂。按Frankel分级：术前C级2例，D级4例，E级4例；术后神经功能评估结果显示，2例C级改善至D级，其余8例均恢复至正常。结论小儿齿状突骨折的发现具有延迟性，一期后路/联合前路松解复位钉棒固定融合技术是治疗难治性儿童齿状突骨折合并寰枢椎脱位的一种安全可靠的方法。ObjectiveTo discuss the surgical treatment and its effectiveness of odontoid fracture complicated with atlantoaxial dislocation in children with spinal cord injury. MethodsFrom January 2010 to December 2014, 10 cases of children under 14 years old, with intractable odontoid fracture with atlantoaxial dislocation were enrolled. The mean duration between injury and admission was 8.5 d （range 1-30 d）. The surgery was performed using posterior reduction and internal fixation or anterior release combined with posterior fixation. The medical date including preoperative and postoperative neurological function, degree of reduction and fusion. ResultsAll cases were followed-up for 12-48 months. The last follow-up X ray and CT examinations showed good reduction and fusion. No fixation failure was observed among all the patients. According to the Frankel, the preoperative neurological function was C in 2 cases, D in 4 cases, and E in 4 cases. At the last follow-up, out of 2 cases with Frankel C improved to D, and the other 8 cases were back to normal. ConclusionsDiagnosis of odontoid fracture complicated with atlantoaxial dislocation is usually delayed in children. One-stage posterior reduction and internal fixation or anterior release combined with posterior fixation is an effective and safe surgical procedure for such cases.

关 键 词：儿童 骨折 脱位 骨折固定术 

分 类 号：R726.5[医药卫生—儿科] R726.8[医药卫生—临床医学]