儿童齿状突游离小骨继发寰枢关节脱位的术式选择及疗效观察

The operative methods and clinical observation for os odontoideum with atlantoaxial dislocation in children

中文关键词:  齿状突游离小骨  寰枢椎脱位  内固定  融合  儿童

英文关键词:Os odontoideum  Atlantoaxial dislocation  Internal fixation  Fusion  Children

中文摘要:

  【摘要】 目的：探讨儿童齿状突游离小骨继发寰枢关节脱位的手术方式，并观察其临床疗效。方法：2009年1月~2014年1月收治12例儿童齿状突游离小骨继发寰枢椎脱位患者，其中7例可复性脱位患者行后路寰枢椎融合术，4例难复性脱位或复位后脊髓前方存在压迫的患者行前路经口咽减压联合后路寰枢椎融合术，1例难复性脱位患者行前路经口咽减压联合后路枕颈融合术，术后1、3、6、12个月及末次随访时评估患者临床表现及影像学改变。结果：所有患者均获得随访，随访时间28±15个月（12~60个月）；术后患者临床症状均得到明显改善，11例短节段融合固定患者颈部屈伸活动功能良好，轴向旋转稍受限；1例患者术后8个月出现内固定断裂及寰枢椎脱位，行后路翻修手术后6个月植骨融合，其余患者均在术后6.0±2.5个月（3~12个月）植骨融合。末次随访时，患者JOA评分由术前的9.6±1.4分提高到16.2±0.7分。结论：后路植骨融合内固定术是治疗儿童齿状突游离小骨继发寰枢关节脱位安全有效的方法，对于难复性脱位患者或复位后存在软组织对脊髓构成持久压迫的患者需联合前路经口咽减压。

英文摘要:

  【Abstract】 Objectives: To investigate the operative methods and clinical effects for os odontoideum with atlantoaxial dislocation in children. Methods: From January 2009 to January 2014, twelve patients with atlantoaxial dislocation secondary to os odontoideum were analyzed retrospectively. Seven patients with reducible alantoaxial dislocation were treated by posterior atlantoaxial fixation and fusion, 4 patients with irreducible alantoaxial dislocation were treated by combined transoral approach decompression and posterior bone fusion and C1-2 instrumentation, the other 1 patient with irreducible alantoaxial dislocation was treated by combined transoral approach decompression and posterior occipitocervical fusion. Clinical manifestations and imaging changes were followed up regularly. Results: All patients were followed up for an average of 28±15 months(range, 12-60 months). All patients gained significant improvement in clinical symptoms. Good flexion and extension function of the neck was achieved in the patients treated by short-segment fixation and fusion. 1 patient suffered from instrument broken and atlantoaxial dislocation 8 months after the operation, posterior approach revision was performed, and bony fusion was obtained after another 6 months. For the others, bony fusion was obtained at follow-up for an average of 6.0±2.5 months(range, 3-12 months). The average JOA score was improved from preoperative 9.6±1.4 points to 16.2±0.7 points at the final follow-up. Conclusions: Posterior internal fixation and fusion is a safe and effective method for the treatment of os odontoideum with atlantoaxial dislocation in children, and transoral approach release is necessary for those patients with irreducible alantoaxial dislocation and reducible alantoaxial dislocation but with consistent soft compression in front of spinal cord.