椎弓根螺钉技术在学龄前儿童寰枢椎脱位治疗中的应用  

Application of atlantoaxial pedicle screw fixation for preschool children atlantoaxial dislocation

作　　者：张跃辉[1] 邵将[1] 宋佳[1] 张竞[1] ZHNAGYue-hui;SHAO Jiang*;SONGJia;ZHANG Jing(Department of Orthopaedics, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China)

机构地区：[1]上海交通大学医学院附属新华医院骨科,上海200092

出　　处：《脊柱外科杂志》2016年第4期211-215,共5页Journal of Spinal Surgery

摘　　要：目的探讨寰枢椎椎弓根螺钉技术在2~5岁学龄前儿童寰枢概位手术治疗中的应用效果。方法2008年9月一2015年8月采用颈椎后路椎弓麵钉钉棒系统治疗寰枢椎脱位学龄前患儿15例，男10例，女5例；年龄24~60个月，平均39.8个月。患儿主要表现为颈部疼痛、活动受限，5例患儿有颈髓压迫症状，美国脊髓损伤协会(ASIA)分级C级2例，D级3例。术前常规行张口位和伸屈动力侧位X线、CT三维重建及MRI检查。麻醉后行颇骨牵引手法复位，对于可完全复位及部分复位的13例患儿，行俯卧位后路手术；对不能复位的2例患儿，先前路松解再翻身行后路手术。直视下置人寰枢椎螺钉，并完成复位及固定植骨融合。早期5例患儿行自体體骨块植骨，后期8例患儿行异体骨植骨，另2例患儿未植骨。结果15例患儿手术过程顺利，共置人54枚螺钉，其中寰枢椎椎弓麵钉49枚，寰椎侧块螺钉3枚，枢椎棘突椎板螺钉2枚，未发生脊髓、神经根及椎动脉损伤。术中出血量30~ 150 m L,平均80 m L ;手术时间80-200 rain,平均110 min。所有患儿随访6~60个月，平均32.6个月。患JL ^ 后3个月随访时均无明显颈部疼痛症状，无明显活动受限。5例术前神经功能异常患儿在术后6个月随访时均恢复至E级。自体體骨植骨患儿寰枢椎融合时间为3~6个月，平均4.2个月；异体骨植骨患儿寰枢椎融合时间为6~9个月，平均7.3个月。结论对寰枢椎明显脱位的学龄前儿童可以考虑施行后路寰枢椎复位、固定植骨融合术，常规直径3.5腿的椎弓擁钉钉棒系统可以用于大多数2~5岁学龄前患儿寰枢椎固定。Objective To evaluate the effect of posterior pedicle screw rod system in the treatment of atlantoaxial dislocationin 2-5 years old preschool children. Methods Fifteen children with atlantoaxial dislocation were studied by a retrospectiveanalysis, consisting of 10 boys and 5 girls, aging 24 to 60 months old( average 39.8 months ). All of the children complainedof neck pain/posterior occipital headache and limitation of neck motion, and 5 of them had symptoms of myelopathy, grade Gin 2 and grade D in 3 according to American spinal injury association( ASIA ). All of children received roentgenograph, MRIand CT three-dimensional reconstruction. According to the types of atlantoaxial dislocation, posterior operation was performedfor reducible dislocation in 13 cases, anterior atlantoaxial release was performed firstly for irreducible dislocation in 2 cases.Atlantoaxial screw placement under direct vision intraoperatively, reduction and fixation were administered in all cases. Fivecases were treated with autogenous iliac bone graft for atlantoaxial fusion, 8 with allograft bone grafting, and the other 2 withno bone grafting. Results All of the 15 operations were completed successfully. A total of 54 screws were placed, includingatlantal 49 pedicle screws, 3 atlantal mass screws, 2 axial laminar screws. There were no intraoperative and postoperativecomplication( neurological, vertebral artery injury and wound infection). Overall, the estimated blood loss was 30-150 mL( mean 80 mL ), and operative time was 80-200 min ( mean 110 min ). The 15 children were followed up for 6-60 months ( mean32.6 months ). Complains of neck pain and limitation of neck motion disappeared 3 months after surgery. The neurologicalfunction had improved obviously in 5 patients with neurological deficit, from grade C, D to grade E 6 months after surgery. The atlantoaxial fusion occurred during 3-6 months ( mean 4.2 months ) in the children receiving autogenous bone grafting, and6-9 months ( mean 13 months) in those ttrdergoing allografting. Conclu

关 键 词：寰椎 枢椎 脱位 骨钉 儿童 学龄前(2~5) 脊柱融合术 

分 类 号：R681.531[医药卫生—骨科学]