儿童陈旧性枢椎齿突骨骺滑脱的手术治疗  

Surgical treatment of post-traumatic epiphyseolisthesis at odontoid process in children

作　　者：梁卫东[1] 盛军[1] 任周梁 荀传辉[1] 郭海龙[1] 买尔旦·买买提[1] 普拉提·买买提[1] 邓强[1] 盛伟斌[1] Liang Weidong;Sheng Jun;Xun Chuanhui;Guo Hailong;Maierdan·Maimaiti;Pulati·Maimaiti;Deng Qiang;Sheng Weibin(Department of Spine Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumchi 830054,China)

机构地区：[1]新疆医科大学第一附属医院脊柱外科,乌鲁木齐830054

出　　处：《中华骨科杂志》2020年第14期911-918,共8页Chinese Journal of Orthopaedics

摘　　要：目的:探讨儿童陈旧性枢椎齿突骨骺创伤性滑脱手术方法及适应证,并评价其治疗结果和预后。方法:回顾性分析2009年7月至2016年10月共5例于我院接受手术治疗的陈旧性齿突骨骺滑脱患儿资料,其中男1例,女4例;年龄(39.6±19.4)个月(范围:19~64个月);病程(87.0±95.1)d(范围:20~240 d)。所有患者术前均拍摄颈椎正侧位、动力位X线片,行枕颈区CT扫描及三维重建,并行枕颈区MR检查以评估分型和脊髓受压情况。分别采用前路松解联合后路固定融合术或后路松解复位内固定手术治疗。采用Frankel评分评价手术前后脊髓功能情况;术后随访拍摄颈椎正、侧位及动力位X线片了解植骨融合状况,必要时行CT扫描。结果:本组5例手术时间为(101.0±20.7)min(范围:75~145 min);术中出血量(70.0±21.2)ml(范围:50~100 ml);1例牵引复位欠佳患儿经前路松解后行后路C 1~2经侧块螺钉内固定,4例行单纯后路C 1~2经侧块螺钉内固定。5例随访时间(23.5±17.6)个月(范围:11~37个月)。术前2例合并神经损害表现者Frankel分级分别为C级和D级,术后3~6个月均恢复至E级。所有患儿枢椎齿突骨骺脱位获得完全复位2例,不完全复位2例,未复位1例。枢椎齿突骨骺脱位和植骨于术后(9.5±3.4)个月(范围:6~15个月)获得融合。颈椎生理曲度维持良好,无植骨吸收、脱落、骨不连、假关节形成及螺钉松动、断裂等现象。至末次随访已拆除内固定2例。结论:儿童陈旧性枢椎齿突骨骺创伤性滑脱罕见,结合病史、临床表现及影像学检查系统评估病情,后路C 1-2经侧块螺钉内固定技术可以达到减压、重建和稳定脊柱序列的目的。Objective To evaluated the indications,methods,outcomes and prognosis of surgical treatment for post-traumatic epiphyseolisthesis at odontoid process in children.Methods Retrospective analysis was performed on 5 cases of children with delayed epiphyseolisthesis of odontoid process in our institution from July 2009 to October 2016,including 1 male and 4 females.Initial surgery age were at1.7~5.4 years old,averaged(39.6±19.4)months and were 0.67-8 months,averaged(87.0±95.1)days.Disease duration ranged from 23 days to 8 months,with an average of 88 days.X-ray,CT and MRI examinations of the occipital-cervical area were taken to evaluate the type of the fracture and the severity of spinal cord compression.Children were treated with anterior loosening combined with posterior fixation fusion or posterior loosening reduction and internal fixation respectively.The function of spinal cord was evaluated by Frankel scale at pre-and post-operation.During the follow-up,X-ray and CT were performed to assess the fusion condition of the grafted bone.Results The duration of operation was ranged from 75-145 months,with an average of(101.0±20.7)months;Blood loss ranged from 50-100 ml,with an average of(70.0±21.2)ml;follow-up duration ranged from 6 to 48 months,with an average of(23.5±17.6)months.Two cases preoperatively evaluated as Frankel C and D recovered to postoperative Frankel E.Among the five cases,two received satisfactory reduction,two cases received incomplete reduction,and one experienced failure reduction.The epiphyseolisthesis and bone grafted sites achieved solid fusion at 6-15 months after surgery,with an average of(9.5±3.4)months.The physiological curvature of cervical remained well without bone resorption,nonunion,pseudoarthrosis,as well as screw loosening or broken.Internal fixation of 2 cases were removed.Conclusion Children with post-traumatic epiphyseolisthesis at odontoid process are not common in clinical practice.The detailed diagnosis of medical history,physical examination and comprehensive imaging ev

关 键 词：儿童 齿突尖 骨骺脱离 治疗结果 

分 类 号：R726.8[医药卫生—儿科]