椎弓根螺钉内固定术治疗儿童寰枢椎脱位的颈椎活动功能观察

C_(1,2)pedicle screw fixation for pediatric atlantoaxial dislocation: an follow-up observation

目的探讨寰枢椎椎弓根螺钉内固定手术治疗儿童寰枢椎脱位的颈椎活动功能康复和临床疗效。方法2005年9月-2013年3月对21例儿童寰枢椎脱位患者采用寰枢椎椎弓根螺钉内固定术治疗,男12例,女9例;年龄5-14岁,平均8.9岁。术前颈椎活动度（range of motion,ROM）为前屈26.32°±5.43°、后伸49.58°±4.38°、左旋42.68°±4.46°、右旋41.55°±5.33°、左侧屈28.31°±5.47°、右侧屈27.82°±5.85°。术中采用＂寰椎椎弓根显露置钉法＂置钉。随访患者神经功能改善和颈椎活动功能情况。结果 21例均行双侧寰枢椎椎弓根螺钉内固定并置钉成功。随访12-92个月,平均32.5个月,术后3-6个月寰枢椎均骨性融合。末次随访颈椎ROM前屈48.12°±4.92°、后伸57.91°±5.15°、左旋58.37°±5.36°、右旋57.51°±5.74°、左侧屈36.57°±4.39°、右侧屈37.44°±4.53°。结论椎弓根螺钉内固定技术治疗儿童寰枢椎脱位,能提供可靠的寰枢椎短节段固定融合和稳定性重建,是一种使颈椎活动功能得到有效康复的治疗方法。

Objective To investigate the clinical outcome and rehabilitation of C1,2pedicle screw fixation for pediatric atlantoaxial dislocation. Methods From September 2005 to March 2013,21 cases suffering from pediatric atlantoaxial dislocation and undergoing atlantoaxial pedicle screw instrumentation were reviewed retrospectively. There were 12 males and 9females with the age at time of surgery ranging from 5 to 14 years（ mean,8. 9 years）. The range of motion（ ROM） in cervical spine were measured as flexion 26. 32° ± 5. 43°,extension 49. 58° ± 4. 38°,left rotation 42. 68° ± 4. 46°,right rotation41. 55° ± 5. 33°,left bending 28. 31° ± 5. 47° and right bending 27. 82° ± 5. 85°. All the patients had C1 pedicle screws placed as part of the fixation construct with pedicle exposure method（ PEM）. The neurological function and the ROM in cervical spine were used to evaluate the surgical outcome. Results All 21 patients underwent bilateral atlantoaxial pedicle screw fixation successfully. All cases were followed up from 12 to 92 months（ on an average of 32. 5 months）. The ROM in cervical spine was measured in all cases at the final follow up as flexion 48. 12° ± 4. 92°,extension 57. 91° ± 5. 15°,left rotation58. 37° ± 5. 36°,right rotation 57. 51° ± 5. 74°,left bending 36. 57° ± 4. 39°,right bending 37. 44° ± 4. 53°. Conclusion C1,2pedicle screw fixation can provide reliable short-segmental fixation,fusion and reconstruction of stability. And it is an effective treatment with satisfactory cervical motion rehabilitation for pediatric atlantoaxial dislocation.