儿童腺样体切除术后寰枢椎半脱位6例并文献复习  

Six cases of atlantoaxial subluxation after adenoidectomy in children and literature review

作　　者：常换换 党攀红 胡春燕 王洁[1] CHANG Huanhuan;DANG Panhong;HU Chunyan;WANG Jie(Department of Otorhinolaryngology&Head and Neck Surgery,Xi'an Children's Hosopital,Xian 710002,Shaanxi,China)

机构地区：[1]西安市儿童医院耳鼻咽喉头颈外科,陕西西安710002

出　　处：《山东大学耳鼻喉眼学报》2025年第1期110-116,共7页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：国家自然科学基础研究计划(82000959)。

摘　　要：目的探讨儿童腺样体伴或不伴扁桃体切除术后出现寰枢椎半脱位(atlantoaxial subluxation,AARS)可能的发生原因。方法对2014年1月至2023年12月间在本院经鼻内镜下低温等离子腺样体伴或不伴扁桃体切除术后出现AARS的6例患儿的临床资料进行回顾,分析其临床、放射学表现以及血常规结果、治疗方法。结果6例患儿术后第2~7天均出现颈痛、颈活动障碍、发热,均无神经压迫症状,部分患儿出现斜颈、枢椎棘突压痛等症状,全部行放射学寰枢关节张口正位及侧位X片或CT检查,均显示齿突侧间隙差值(variance of bilateral the latenal atlanto-dental internal,VBLADI)>2.2 mm、寰齿前间隙(atlanto-dental internal,ADI)<3.0 mm,均为Fielding-HawkinsⅠ型。全部患儿术后均出现感染,细菌感染5例、病毒感染1例,术后均行抗感染治疗、颈托和(或)颈椎牵引治疗并治愈。结论患儿腺样体切除术后出现颈痛、颈活动障碍、发热等症状时,应考虑为椎前淋巴结炎或AARS,放射学寰枢椎张口正位及侧位X片或CT检查可鉴别诊断,寰枢椎CT可以更好地对AARS进行分类,一旦确诊AARS并分类为Fielding-HawkinsⅠ型,应尽早行抗感染,同时行颈托和(或)颈椎牵引等保守治疗,以防止出现神经后遗症。Objective To review the potential causes of atlantoaxial subluxation(AARS)after adenoidectomy in children,and to summarise experience in diagnosis and management to prevent its occurrence.Methods The clinical data of six cases of AARS patients who underwent nasal endoscopic low-temperature plasma adenoidectomy and(or)tonsillectomy in our hospital from January 2014 to December 2023 were retrospectively reviewed.Their clinical manifestations,radiological findings,blood test results,and treatment approaches were analysed.Results All ARRS patients presented with neck pain,limited neck mobility and fever within 2-7 days postoperatively,without any neurological symptoms.Some patients had torticollis and cervical spine tenderness.All patients underwent radiological examination of the atlantoaxial joint in the open-mouth positive position and in the lateral position with X-ray or CT scan,showing a variance of the bilateral lateral atlanto-dental space(VBLADI)>2.2 mm and an atlanto-dental interval(ADI)<3.0 mm belonging to the Fielding-Hawkins Ⅰ type.All patients had a postoperative infection,with five cases of bacterial infection and a case of viral infection.All patients received antibiotic treatment,cervical collar,and(or)cervical traction,which were effective in curing AARS.Conclusion If patients have neck pain,limited neck mobility,fever,etc.after adenoidectomy,it should be considered as cervical lymphadenitis or AARS.Radiological examination of the atlantoaxial joint in the open-mouth positive position and in the lateral position by X-ray or CT scan may help to differentiate the diagnosis.A CT scan of the cervical spine can better classify AARS.Once AARS is diagnosed and classified as Fielding-Hawkins type Ⅰ,early conservative treatment such as antibiotic treatment,cervical collar and(or)cervical traction should be given as soon as possible to prevent neurological sequelae.

关 键 词：腺样体切除术 扁桃体切除术 寰枢椎半脱位 Grisel综合征 感染 

分 类 号：R762[医药卫生—耳鼻咽喉科]