后路椎弓根螺钉内固定治疗儿童寰枢椎脱位的远期效果

Long-term follow-up of C1 - C2 pedicle screw fixation for pediatric atlantoaxial dislocation

目的探讨后路椎弓根螺钉内固定治疗儿童寰枢椎脱位的远期效果。方法回顾性分析2005年3月至2011年4月在解放军第一七五医院收治的21例儿童寰枢椎脱位患儿的临床资料。其中男12例，女9例；年龄3～9岁，平均6．1岁；14例为I型不稳定寰枢椎脱位，7例为Ⅱ型牵引可复位寰枢椎脱位；患儿均接受后路椎弓根螺钉内固定术。术前及末次随访时分NOn0量颈椎侧位x线片颈椎整体曲度、曲度角度及下颈椎的稳定性大小来评价该术式对儿童发育的影响，并观察神经功能变化及植骨融合效果等。结果患儿均获得随访，随访时间65～127个月，平均96．4个月，6个月内均达到骨性愈合；术前颈椎整体曲度分布：前凸9例、垂直12例，与术后的整体曲度（前凸12例、垂直9例）差异无统计学意义（P=0．354）；末次随访时，整体曲度前凸17例，垂直4例，与术后的整体曲度相比差异无统计学意义（P=0．095）；患儿均未出现后凸及鹅颈畸形；术后颈椎曲度角度显著小于术前（15．5°±2．5°比31．7°±4．2°，P〈0．001）；末次随访曲度角度（19．1°±2．7°）与术后差异无统计学意义（P=0．343）；患儿均未出现下颈椎不稳的影像学表现；术前4例患儿合并神经损伤，其中2例FrankelB级，l例FrankelC级，1例FrankelD级，术后3个月随访，神经功能均得到不同程度的恢复。结论后路椎弓根螺钉内固定治疗儿童寰枢椎脱位远期效果良好。

Objective To investigate the clinical curative effect of C1 - C2 pedicle screw fixation for pediatric atlantoaxial dislocation after a long-term follow-up. Methods From March 2005 to April 2011, a total of 12 male and 9 female patients were included, with age from 3 to 9 years old （ mean, 6. 1 years old）. Among them, 14 cases （67%） had type I instability atlantoaxial dislocation, 7 cases （33%） had type lI reducible atlantoaxial dislocation. All 21 pediatric patients with atlantoaxial dislocation underwent posterior pedicle screw fixations. Frankel Grade was used to evaluate function before and after treatment. Furthermore, the information of CI -C2 bony fusion, cervical spine alignment, angle of sagittal curvature, and instability of the subaxial spine were collected ｜Yore all patients preoperatively, immediately postoperatively and during follow-up period. Results duration of 96. 4 months （range, 65 to 127 months） All 21 patients had regular follow-up with an average All children had good bony fusion within 6 months after treatment. There were 9 patients with lordotic alignment and 12 patients with straight alignment before surgery. After surgery, there were 12 patients with lordotic alignment and 9 patients with straight alignment. At the time of the last follow-up, 17 patients had lordotic alignment and 4 patients had straight alignment. No difference was found between pre- and post-operation （ P = 0. 354）. The same result was found between post- operation and last follow-up （P = O. 095）. Neither kyphotic nor swan-neck deformity was found in any of the 21 patients. The mean angle of sagittal curvature decreased from 31.7° ±4. 3°preoperatively to 15.5 ° ± 2. 5°postoperatively （P〈 0. 001 ） . The mean angle of sagittal curvature increased from 15.5° ±2. 5° postoperatively to 19. 1°±2.7°at the final follow-up （P= 0. 343）. No spinal deformities or subaxial instabilities were fbund. Of the four patients with preoperative neurological defects, Frankel Grade was significantly improved at 3 months follow-up compared with pretreatment values. None of the patientsexperienced worsening neurological symptoms or injury to the vertebral artery. Conclusion The results demonstrate that C1 - C2 pedicle screw fixation could achieve satisfactory clinical effects for the management of pediatric atlantoaxial dislocation with long-term follow-up.