小儿颈椎损伤62例临床分析

Clinical analyses of cervical spine injury in 62 children

目的探讨小儿颈椎损伤的个体化诊断特点、外科治疗策略及方法。方法回顾性分析2002年3月至2012年12月收治的颈椎损伤患儿62例。男48例，女14例；年龄3～12岁，其中3～6岁25例，7～12岁37例，平均7．5岁。外伤至就诊时间为1d～50周，平均5．5N。损伤节段为C0～3患儿36例，其中寰椎横韧带断裂2例，寰枢关节旋转固定或脱位26例，齿状突软骨联合部骨折4例；C4～7患儿17例；无骨折脱位表现的颈脊髓损伤9例。根据不同病情分别给予卧床并用Glission颌枕带或颅骨牵引、Halo-Vest支架、头颈胸石膏、迪克夹板或费城颈托外固定、甲基强的松龙（meth-ylprednisolone，MP）冲击治疗以及手术治疗。结果手术治疗14例，牵引或头颈胸支具治疗45例，未采取特殊治疗措施3例，住院时间9～40d，平均16d；全部随访2～69个月，平均25个月，均取得良好临床疗效。结论小儿颈椎尚处于发育阶段，其解剖结构和生物力学特点随着发育进程呈现动态变化，小儿颈椎在遭受外伤时无论损伤机制、临床表现、外科治疗策略及方法与成人不同，且不同年龄组的小儿颈椎损伤也存在较大差异，外科治疗应遵循个体化原则，严格掌握手术适应证。

Objective To discuss the characteristics, strategies and methods of individualized diagnosis and surgical treatment of cervical spine injury in children. Methods A total of 62 children of cervical spinal injury were analyzed retrospectively from March 2002 to December 2012. There were 48 boys and 14 girls with an average age of 7. 5 （3 - 12） years. Among them, the ages were 3 - 6 years （n = 25） and 7- 12 years （n = 37）. The average visiting time after injury was 5. 5 weeks （1 day to 50 weeks）. Among 36 cases at C0-3, there were atlas transverse ligament rupture （n = 2） ; atlantoaxial rotatory fixation or dislocation （n = 26） and odontoid synchondrosis fracture （n = 4） ; for 17 cases at C4-7; spinal cord injuries without any fracture and dislocation were found in 9 cases. According to different conditions, they received Glission belt or skull traction and Halo-Vest support, head-neck- chest plaster, Dick splint or Philadelphia collar external fixation, methylprednisolone （MP） impact therapy and surgery, Results The interventions included surgical operation （n = 14）, skull traction or head and neck chest orthosis （n = 45） and no special measure （n = 3）. The average hospitalization stay was 16 （9 - 40） days. During an average follow-up period of 25 （2 - 69） months, all patients achieved excellent clinical efficacies. Conclusions Anatomical structure and biomechanics of cervical spine in children undergo dynamic developments. Therefore injury mechanism, clinical representation and surgical strategy in children are different from those in adults. Surgery should be individualized and operative indication strictly controlled.