双侧寰椎椎板挂钩及寰枢椎关节间隙螺钉治疗学龄期儿童急性Ⅰ型横韧带损伤
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作者Author单位AddressE-Mail
林佩达 LinPeidaGuoxiang 浙江普陀医院 Zhejiang Putuo Hospital 1640608873@qq.com 
倪斌* NiBin 海军军医大学附属长征医院 Changzheng Hospital Affiliated to Naval Military Medical University newspine@163.com 
期刊信息:《中国骨伤》年,第卷,第期,第-页
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中文摘要:目的评估学龄期儿童急性Ⅰ型横韧带损伤致寰枢椎脱位使用双侧寰椎椎板挂钩及寰枢椎关节间隙螺钉结合自体髂骨植骨的手术疗效。方法2006年2月-2019年2月,系统回顾8例因急性Ⅰ型横韧带损伤致寰枢椎脱位的学龄期儿童,男6例,女2例;年龄9-12岁,平均10.7岁;急性损伤8例,包括4例高位摔伤、2例车祸、2例运动伤;寰齿间距(atlantodentalinterval,ADI)均≥5mm,最大8mm,平均6.6mm;8例患儿出现不同程度的枕颈部疼痛、僵硬、麻木及颈椎旋转功能障碍,其中2例伴有神经压迫,ASIA分级D级;术前C1-2角平均21.5o;所有患者均接受颅骨牵引,并在完全复位或寰枢椎基本复位后接受手术治疗。观察患儿治疗前后日本矫形外科学会(Japanese orthopaedic association,JOA)评分、寰椎平面脊髓有效空间(spaceavailable for the cord,SAC)及颈椎功能障碍指数(neck disability index,NDI)、ADI、ASIA分级(美国脊髓损伤协会(ASIA)损伤分级(1992))及C1-2角的变化。结果术前患儿的JOA评分、SAC、NDI分别为(14.15±1.26)分、(9.74±2.12)mm、(38.24±10.13),末次随访的JOA评分、SAC、NDI分别为(16.63±0.37)分、(14.69±1.79)mm、(18.21±7.16),数值有明显改善,差异有统计学意义(P<0.05);ADI由术前平均6.6mm降为均值1.6mm;2例ASIA分级D级患儿恢复到E级;C1-2角手术前平均21.5o改善为27.2o。结论双侧寰椎椎板挂钩及寰枢椎关节间隙螺钉结合自体髂骨植骨操作简便,出血少,稳定性强,植骨融合率高,是学龄期儿童急性Ⅰ型横韧带损伤伴寰枢椎脱位理想的手术方案。
【关键词】急性损伤 学龄儿童 横韧带损伤 寰枢椎脱位 手术
 
Bilateral atlantoaxial lamina hook and atlantoaxial joint space screw for acute type I transverse ligament injury in school-age children
ABSTRACT  Objective To evaluate the effect of bilateral atlantoaxial lamina hook and atlantoaxial joint space screw combined with autologous iliac bone graft on atlantoaxial dislocation caused by acute type I transverse ligament injury in school-age children.Methods From February 2006 to February 2019, 8 school-age children with atlantoaxial dislocation caused by acute type I transverse ligament injury were systematically reviewed, including 6 males and 2 females; aged 9-12 years, with an average age of 10.7 years; 8 acute injuries, including 4 high-level falls, 2 car accidents and 2 sports injuries; the atlantoaxial interval (ADI) was more than 5 mm, with an average of 6.6 mm; and 8 children with different degrees of atlantoaxial dislocation. The pain, stiffness, numbness in occipitocervical region and cervical spine rotatory dysfunction were observed in 2 patients with nerve compression and ASIA grade D. The preoperative C1-2 angle averaged 21.5°.All patients received cranial traction and received surgical treatment after complete reduction or atlantoaxial reduction. To observe the changes of Japanese Orthopaedic Association (JOA) score, space available for the cord (SAC), neck disability index (NDI), ADI, ASIA classification (ASIA) injury classification (1992) and C1-2 angle before and after treatment.Results The JOA score, SAC and NDI of preoperative children were (14.15 +1.26), (9.74 +2.12) mm, (38.24 +10.13). The JOA score, SAC and NDI of the last follow-up were (16.63 +0.37), (14.69 +1.79) mm and (18.21 +7.16). The difference was significant (P<0.05). The ADI decreased from preoperative average 6.6 mm to mean 1.6 mm. Two ASIA D children recovered to C1-2 angle. The average improvement before operation was 21.5°and 27.2°.Conclusions Bilateral atlantoaxial lamina hook and atlantoaxial joint space screw combined with autologous iliac bone graft is simple, less bleeding, strong stability and high fusion rate. It is an ideal surgical procedure for acute type I transverse ligament injury with atlantoaxial dislocation in school-age children.
KEY WORDS  Acute injury  School-age children  Type I transverse ligament injury  Atlantoaxial dislocation  Surgery
 
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