儿童陈旧性寰枢椎旋转半脱位的治疗选择

Treatment strategy for chronic atlantoaxial rotatory subluxation in children

目的探讨儿童陈旧性寰枢椎旋转半脱位的治疗方法。方法自1998年3月～2007年6月收治23例陈旧性寰枢椎旋转半脱位患儿。确诊时间平均4.1个月。入院后予颅骨牵引,完全复位者行头颈胸石膏固定2个月。部分复位及复位后再脱位的行后路寰枢椎复位融合术。脱位无明显改善的行前路下颌下入路松解粘连后后路复位内固定。结果Ⅰ型脱位5例中4例牵引复位其中1例再脱位;1例不能复位。Ⅱ型14例中9例牵引复位,其中6例再脱位;5例不能复位。Ⅲ型4例中1例牵引复位后再脱位;3例不能复位。随访显示23例斜颈畸形得到明显矫正,患儿没有明显的颈部疼痛。结论大部分陈旧性脱位闭合复位困难,复位后再脱位发生率高需要手术治疗。手术复位融合寰枢椎治疗效果满意。

Objective To investigate the optimal treatment for chronic atlantoaxial rotatory subluxation in children. Methods Between Mar. 1998 and Jun. 2007, 23 children diagnosed as chronic atlantoaxial rotatory subluxation were admitted. The dislocation-therapy interval was 2-16 months （average 4.1 months）. All children were treated with skull traction for up to 2 weeks. If reduction was completed,patients were treated with plaster support for another 2 months. Patients with recurrent dislocation and patients with obviously improved appearance after incomplete reduction were treated with open reduction and atlantoaxial fusion posteriorly by modified Gallie technique. Patients without obvious reduction were treated with posterior atlantoaxial fixation after retrophalangeal release of atlantoaxial complex. Results Of the patients with type I ,four had reduction,among which one had recurrent dislocation. Of the patients with type II ,nine had reduction,among which six had recurrent dislocation. Of the patients with typelll ,only one had reduction but suffered dislocation later. At follow up,wry necks were obviously corrected in all patients. Patients felt no pain. Conclusion Mostly closed reduction is difficult for chronic aflantoaxial rotatory subluxation and the rate of recurrent dislocation is high. Most patients need surgery with satisfactory recovery.