| 张跃辉,邵将,宋佳,张竞.椎弓根螺钉技术在学龄前儿童寰枢椎脱位治疗中的应用[J].脊柱外科杂志,2016,14(4):211-215. |
椎弓根螺钉技术在学龄前儿童寰枢椎脱位治疗中的应用  点此下载全文 (Fulltext) |
| 张跃辉 邵将 宋佳 张竞 |
| 上海交通大学医学院附属新华医院骨科, 上海 200092 |
| 基金项目： |
| DOI：10.3969/j.issn.1672-2957.2016.04.006 |
| 摘要点击次数: 956 |
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| 摘要： |
| 目的 探讨寰枢椎椎弓根螺钉技术在2～5岁学龄前儿童寰枢椎脱位手术治疗中的应用效果。方法 2008年9月-2015年8月采用颈椎后路椎弓根螺钉钉棒系统治疗寰枢椎脱位学龄前患儿15例，男10例，女5例；年龄24～60个月，平均39.8个月。患儿主要表现为颈部疼痛、活动受限，5例患儿有颈髓压迫症状，美国脊髓损伤协会（ASIA）分级C级2例，D级3例。术前常规行张口位和伸屈动力侧位X线、CT三维重建及MRI检查。麻醉后行颅骨牵引手法复位，对于可完全复位及部分复位的13例患儿，行俯卧位后路手术；对不能复位的2例患儿，先前路松解再翻身行后路手术。直视下置入寰枢椎螺钉，并完成复位及固定植骨融合。早期5例患儿行自体髂骨块植骨，后期8例患儿行异体骨植骨，另2例患儿未植骨。结果 15例患儿手术过程顺利，共置入54枚螺钉，其中寰枢椎椎弓根螺钉49枚，寰椎侧块螺钉3枚，枢椎棘突椎板螺钉2枚，未发生脊髓、神经根及椎动脉损伤。术中出血量30～150 mL，平均80 mL；手术时间80～200 min，平均110 min。所有患儿随访6～60个月，平均32.6个月。患儿术后3个月随访时均无明显颈部疼痛症状，无明显活动受限。5例术前神经功能异常患儿在术后6个月随访时均恢复至E级。自体髂骨植骨患儿寰枢椎融合时间为3～6个月，平均4.2个月；异体骨植骨患儿寰枢椎融合时间为6～9个月，平均7.3个月。结论 对寰枢椎明显脱位的学龄前儿童可以考虑施行后路寰枢椎复位、固定植骨融合术，常规直径3.5 mm的椎弓根螺钉钉棒系统可以用于大多数2～5岁学龄前患儿寰枢椎固定。 |
| 关键词：寰椎 枢椎 脱位 骨钉 儿童,学龄前(2~5) 脊柱融合术 |
| Application of atlantoaxial pedicle screw fixation for preschool children atlantoaxial dislocation Fulltext |
| ZHNAG Yue-hui SHAO Jiang SONG Jia ZHANG Jing |
| Department of Orthopaedics, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China |
| Fund Project: |
| Abstract: |
| Objective To evaluate the effect of posterior pedicle screw rod system in the treatment of atlantoaxial dislocation in 2-5 years old preschool children. Methods Fifteen children with atlantoaxial dislocation were studied by a retrospective analysis,consisting of 10 boys and 5 girls,aging 24 to 60 months old(average 39.8 months). All of the children complained of neck pain/posterior occipital headache and limitation of neck motion,and 5 of them had symptoms of myelopathy,grade C in 2 and grade D in 3 according to American spinal injury association(ASIA). All of children received roentgenograph,MRI and CT three-dimensional reconstruction. According to the types of atlantoaxial dislocation,posterior operation was performed for reducible dislocation in 13 cases,anterior atlantoaxial release was performed firstly for irreducible dislocation in 2 cases. Atlantoaxial screw placement under direct vision intraoperatively,reduction and fixation were administered in all cases. Five cases were treated with autogenous iliac bone graft for atlantoaxial fusion,8 with allograft bone grafting,and the other 2 with no bone grafting. Results All of the 15 operations were completed successfully. A total of 54 screws were placed,including atlantal 49 pedicle screws,3 atlantal mass screws,2 axial laminar screws. There were no intraoperative and postoperative complication(neurological,vertebral artery injury and wound infection). Overall,the estimated blood loss was 30-150 mL (mean 80 mL),and operative time was 80-200 min(mean 110 min). The 15 children were followed up for 6-60 months(mean 32.6 months). Complains of neck pain and limitation of neck motion disappeared 3 months after surgery. The neurological function had improved obviously in 5 patients with neurological deficit,from grade C,D to grade E 6 months after surgery. The atlantoaxial fusion occurred during 3-6 months (mean 4.2 months) in the children receiving autogenous bone grafting,and 6-9 months(mean 7.3 months) in those urdergoing allografting. Conclusion Atlantoaxial pedicle screw fixation has been proved to be an effective treatment for atlantoaxial dislocation in majority of 2-5 years old preschool children. |
| Keywords:Atlas Axis Dislocations Bone nails Child pre(2-5) Spinal fusion |
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