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目的探讨小儿寰枢关节旋转固定或脱位的治疗方法。方法回顾性分析2000年1月至2005年3月收治的小儿寰枢关节旋转固定或脱位32例,男24例,女8例;年龄3～12岁,平均5.5岁。发病至就诊时间为2d～50周,平均6.5周。Fielding-Hawkins临床分型,Ⅰ型17例(伴有游离齿突小骨1例)、Ⅱ型12例(伴有游离齿突小骨、寰椎后弓缺如各1例)、Ⅲ型3例。对牵引后能复位、无神经症状、未出现寰枕关节代偿畸形且不伴有其他枕颈部畸形者26例采用保守治疗,对难复性、有神经症状、出现寰枕关节代偿畸形或伴有其他枕颈部畸形者6例采用颈后路寰枢椎或枕颈融合术。结果全部病例随访3～50个月,平均32个月。保守治疗成功26例,斜颈全部消失,冠状位上两侧块保持对称,旋转及伸屈运动恢复正常。手术治疗的6例均获得植骨融合,原有神经症状消失或减轻,4例斜颈消失,2例斜颈未继续进展。结论对大多数患有寰枢关节旋转固定或脱位的患儿采用非手术治疗可获得满意的治疗结果;而对难复性、有神经症状、出现寰枕关节代偿畸形或伴有其他枕颈部畸形者应行手术治疗。
Objective To investigate the treatment of atlantoaxial joint rotation fixation or dislocation in children. Methods Retrospective analysis of 32 cases of pediatric atlantoaxial joint rotation fixed or dislocated from January 2000 to March 2005, 24 males and 8 females; aged 3 to 12 years old with an average of 5.5 years old. The onset to treatment time is 2d ~ 50 weeks, an average of 6.5 weeks. Fielding-Hawkins clinical classification, type I in 17 cases (accompanied by free odontoid bone in 1 case), type 12 in 12 cases (accompanied by free odontogenic small bone, atlas after the arch of the lack of each one), type III in 3 cases. Twenty-six of 26 patients who were able to be reset after recuperation, had no neurological symptoms, no atlanto-occipital joint deformity and no other occipital deformity were treated conservatively, and were refractory and neurotic with ataxia compensatory deformity Or with other occipital deformities in 6 cases of posterior cervical atlantoaxial or occipital fusion. Results All patients were followed up for 3 to 50 months, an average of 32 months. Conservative treatment of successful 26 cases, all of the torticollis disappeared, both sides of the coronal position to maintain symmetry, rotation and flexion and extension movements returned to normal. 6 cases of surgical treatment were all obtained fusion of bone graft, the original neurological symptoms disappeared or reduced, 4 cases of torticollis disappeared, 2 cases of torticollis did not continue to progress. Conclusion Most patients with atlantoaxial rotational fixation or dislocation can obtain satisfactory results with non-surgical treatment. For patients with recurrent and neurological symptoms, atherosclerosis, or other occipital complications Deformity should be treated surgically.