儿童寰枢椎旋转性半脱位的临床特征分析

Clinical characteristics of atlanto-axial rotatory subluxation in children

目的总结儿童寰枢椎旋转性半脱位(atlanto-axialrotatory subluxation,AARS)的临床特征,为其诊断及治疗提供参考依据。 方法回顾性分析厦门市儿童医院于2014年6月至2018年6月就诊的512例AARS患儿的临床资料及影像学检查结果。 结果512例AARS患儿中男童273例,女童239例;平均年龄(5.6±2.1)岁;168例发病前有上呼吸道感染病史,149例有外伤史;就诊时症状持续时间平均(3.7±1.6)d;23例患儿出现过2次及以上的AARS;按Fielding临床分型:Ⅰ型321例,Ⅱ型143例,Ⅲ型29例,Ⅳ型19例;512例影像学结果除提示AARS外,尚有27例筛查出其他疾病。即6例肿瘤性病灶,5例先天性结构畸形,6例感染性病灶,3例出血性病灶,1例出血伴感染,1例血管畸形,1例血管畸形合并出血,1例血管畸形合并先天性结构畸形,3例颅内囊肿。在接受颈托制动或枕颌带牵引治疗的463例患儿中有461例(99.57%)治疗后临床症状消失。 结论寰枢椎旋转性半脱位常见于上呼吸道感染及外伤后,诊断需结合临床症状及影像学表现,同时需排除肿瘤、感染、出血、先天性结构畸形等疾病,颈托制动及枕颌带牵引治疗效果显著。

Objective To explore the clinical diagnosis and treatment of atlantoaxial rotatory subluxation (AARS) and summarize its clinical features. Methods From June 2014 to June 2018,clinical data and imaging examinations were retrospectively analyzed for 512 AARS children at Xiamen Children s Hospital. Results There were 273 boys and 239 girls with a mean age of (5.6±2.1) years.There was a previous history of upper respiratory tract infection ( n =168) and trauma ( n =149).The mean duration of symptoms was (3.7±1.6) days.Twenty-three of them had AARS more than once.According to the Fielding scheme of clinical classification,the specific types were ( n =321),Ⅱ(n=143),Ⅲ(n=29) and Ⅳ(n=19).Other concurrent diseases were neoplastic lesions ( n =6),congenital structural malformations ( n =5),infectious lesions ( n =6),hemorrhagic lesions ( n =3),hemorrhage & infection ( n =1),vascular malformation ( n =1),vascular malformation plus hemorrhage ( n =1),vascular malformation & congenital structural malformation ( n =1) and intracranial cyst ( n =3).Among 463 children with continuous mandible occipital belt traction and brace,461 had clinical recovery. Conclusion AARS is common after upper respiratory tract infection and trauma.A definite diagnosis is based upon clinical findings and imaging examinations.In the meantime,it is necessary to exclude some diseases such as tumor,infection,hemorrhage and congenital structural malformation.The outcome of continuous mandible occipital belt traction and brace is marked.