目的 探讨唐氏综合征(Down's syndrome, DS)患儿寰枢椎不稳定(atlantoaxial instability, AAI)行颈后路内固定手术的疗效。方法 选择2012-06至2018-11北京儿童医院收治的DS伴AAI患儿12例,其中男5例,女7例,年龄3~14岁,平均(6.9±3.1)岁。术前均行颈椎正侧位+前屈后伸位X线片并行颈椎CT平扫+重建了解椎体、C1侧块、C2椎弓根发育情况及椎动脉(VA)情况,有脊髓受压表现的患儿进一步完善颈椎MR检查。术后定期随访复查颈椎正侧位及前屈后伸位X线片,行颈椎CT平扫+重建了解寰枢椎对位、植骨融合及内固定情况,测量并记录术前、术后及末次随访时的寰齿前间距(atlas-dens interval, ADI)及脊髓有效空间(space available for the spinal cord, SAC)数值。结果 术后随访1.6~4.9年,平均(2.6±1.2)年。10例行C1侧块螺钉及C2椎弓根螺钉固定,2例用枕骨板连接C1、2螺钉行枕-颈固定融合。ADI由术前的(7.0±2.1)mm减小到末次随访时的(1.4±0.8)mm(P<0.01),SAC由术前的(13.6±5.2)mm增加到末次随访时的(19.0±3.0)mm(P<0.01)。术后第3及6个月定期行颈部CT检查,至末次随访时所有患儿均获得了良好的骨性融合。结论 对DS患儿伴AAI行后路C1、C2螺钉固定及枕骨板等内固定可达到良好的治疗效果。
Abstract
Objective To study the effect of posterior internal fixation in children with Down's syndrome(DS) and atlantoaxial instability(AAI).Methods The clinical data on twelve children with Down's syndrome and atlantoaxial instability treated at our hospital between June 2012 and November 2018 was retrospectively analyzed. These patients consisted of 5 males and 7 females, aged 3 to 14, and with an average age of (6.9±3.1) years. All these patients received cervical X-rays and CT scan with reconstruction to find out about the development of the vertebral body, C1 lateral mass, C2 pedicle and vertebral artery (VA). In children with spinal cord compression, MRI examination of the cervical spine was upgraded. The patients were followed up regularly. The X-ray films of the cervical spine and CT scan with 3D reconstruction were performed to detect the levels of atlantoaxial alignment, bone graft fusion and internal fixation. The ADI and SAC values were measured and recorded preoperatively, postoperatively and during the last follow-up.Results The mean follow-up time was (2.6±1.2) years (range 1.6-4.9 years). C1 lateral mass screws and C2 pedicle screws were performed in ten of the twelve children, and the other two cases were treated with occipital plates and C1,2 screws for occipitocervical fixation and fusion. ADI decreased from (7.0±2.1)mm before surgery to (1.4±0.8)mm during the last follow-up (P<0.01), and SAC increased from (13.6±5.2)mm to (19.0±3.0)mm (P<0.01). All the patients underwent regular neck CT examinations in the 3rd and 6th months after operation. By the last follow-up, all the children enjoyed good bone fusion.Conclusions For children with DS and AAI, posterior C1, C2 screw fixation and occipital plate internal fixation can achieve good therapeutic effect.
关键词
唐氏综合征 /
寰枢椎不稳定 /
儿童 /
内固定
Key words
Down's syndrome /
atlantoaxial instability /
children /
fixation
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