儿童先天性寰枢关节脱位后路复位及内固定技术

Direct posterior restoration and internal fixation technique for children with congenital atlantoaxial subluxation

目的探讨儿童先天性寰枢关节脱位后路直接复位及螺钉一钛棒（板）内固定技术的临床效果。方法选择第四军医大学西京医院神经外科自2008年4月至2011年3月收治的7例先天性颅颈交界区不稳定患儿，其中3例伴有扁桃体下疝，4例伴有脊髓空洞，3例寰枕融合。采用枕骨钉一枢椎椎弓根螺钉内固定术．并通过螺钉间撑开技术使寰枢关节复位。根据手术后JOA评分和影像学资料，评价手术疗效。结果7例患儿手术后临床症状明显改善。手术后1个月螺钉位置良好，3个月三维CT检查显示3例颅椎体间融合良好。随访1-15个月，患儿JOA评分平均为（12．03±3．58）分，与手术前（7．56±3．16）分比较差异具有统计学意义（P＜0．05）。结论对适宜儿童寰枢关节脱位病例．后路直接复位及内固定是一种有效治疗手段。

Objective To explore the clinical effect of direct posterior restoration and screw-rod （plate） internal fixation technique for the treatment of children with congenital atlantoaxial subluxation. Methods Seven children with congenital atlantoaxial subluxation, admitted to our hospital from April 2008 to March 2011, were chosen in our study; and 3 of them were combined with tonsil hernia of cerebellum and 3 with occipitalization. Japanese Orthopedic Association （JOA） scale was used to evaluate the patient＇s condition. Five patients were treated by internal fixation with occipital bone screw-axis （C2） pedicle screw and 2 were with atlas C1-C2. Articulatio atlantoepistrophica repositioning was performed during the operation. The post-operative improvement degree and therapeutic effect of these patients were assessed based on the JOA scores and imaging. Results All the patients were followed up for 1-15 months （average 3.2 months）. The clinical symptoms of all patients improved significantly. The positions of all screws were fine 1 month after operation. Three-dimensional CT showed that occipital/interbody fusions were good in 3 patients. JOA scores after the surgery were 7-16 with an average scores of （12.03±3.58）, which were significantly different as compared with those before the surgery （[7.56±3.16], P〈0.05）. Conclusion Direct posterior restoration and internal fixation technique is a safe and effective method for the treatment of children with congenital aflantoaxial subluxation.