Magerl术在儿童寰枢椎不稳中的应用

Using Magerl Surgery in Treatment of Children Atlantoaxial Dislocation

目的探讨Magerl术治疗儿童寰枢椎不稳的可行性和手术成功的关键因素。方法2003年12月～2007年5月,对17例平均年龄10岁(6～15岁)的寰枢椎不稳患者行后路经寰枢椎侧块关节UCSS空心螺钉固定(Magerl术)、植骨融合术,对其中后弓完整的13例同期行后路寰枢椎钛缆固定术(Gllie术)。通过随访并摄寰枢椎张口位和颈椎侧位X线片,评估螺钉位置和植骨融合情况。结果所有患者均完成双侧螺钉固定,症状明显改善,无脊髓神经和椎动脉损伤等并发症。17例经过平均21个月(3～40个月)随访,螺钉位置满意,均获骨性融合,无寰枕关节受限及相邻节段的自发性融合。结论Magerl术治疗儿童寰枢椎不稳是安全、有效的方法,术前寰枢椎的影像学评估和部分经颅环弓牵引后未获得充分复位者术中充分手法复位是手术成功的关键因素。

Objective To discuss the feasibility and technical points of the C1,2 posterior transarcticular UCSS screw fixation on children patients with atlantoaxial dislocation. Methods Between December 2003 and May 2007, 17 patients with atlantoaxial dislocation were treated with bilateral C1.2 posterior tansarticular screw fixation and autologous iliac crest graft, of whom 13 patients with C1 posterior arch intact underwent onestage Magerl surgery combined with C1,2 posterior Gallie. The postoperative CT scan was performed to assess the instrumentation. Results All patients underwent surgery successfully, without severe complications such as injury of nerve or vertebral artery, neurological function improved remarkably. All patients were followed up for 3-40 months （mean, 21 months）. Computed tomographic examination demonstrated that neither penetration of 54 crews and nor spontaneous extensions of the fusion were observed. The atlanto- occipital joint was kept intact in all patients. All patients got C1,2 bony fusion with 3-6 months postoperatively. Conclusion Transarticular screw in management of children atlantoaxial dislocation is effective and safe. The preoperative radiographic evaluation of C1,2 and complete reduction of atlantoaxial dislocation intraoperation are key factors of succession.