摘要
目的建立一种C_(0)-C_(2)枕颈固定并C_(1)-C_(2)后路植骨融合技术治疗儿童寰枢椎脱位的新方法,以降低低龄儿童寰枢椎手术的置钉风险。方法对2例低龄颅颈交界疾病伴寰枢椎脱位患儿施行后路寰枢椎复位和C_(0)-C_(2)枕颈内固定,骨蜡涂抹枕骨表面以降低枕颈融合几率,然后将自体髂骨移植在经处理的C_(1)-C_(2)后方植骨床上,并以明胶海绵将寰枢椎后方植骨材料与枕骨隔离。待寰枢椎后方骨融合完成后去除内固定,恢复枕颈运动功能。结果术程顺利,未出现感染、内固定松动断裂并发症。患儿分别获得18和16个月随访。术后CT复查发现,患儿分别在术后5、6个月形成寰枢椎植骨区域的骨性融合。分别于术后1年、10个月去除枕颈内固定装置,继续随访6个月以上,颈椎屈伸、旋转运动功能恢复满意,寰枢椎复位维持良好,未出现神经脊髓压迫症状。结论C_(0)-C_(2)枕颈固定并C_(1)-C_(2)后路植骨融合技术可为低龄儿童寰枢椎脱位提供一种新方法。
Objective To investigate a novel technique for treating pediatric atlantoaxial dislocation(AAD)by occipital-cervical(C0-C_(2))fixation and atlantoaxial(C_(1)-C_(2))bone implantation for fusion to reduce the risks of pedicle misplacement during atlantoaxial surgery for children with lower ages.Methods Two pediatric patients with lower ages who suffered from craniocervical junction disorders and AAD were treated by posterior atlantoaxial reduction and occipital-cervical(C0-C_(2))fixation procedures.Bone wax was used to cover the surface of occipital bone to prevent occipital-cervical fusion.The autogenous iliac bone graft was placed on the posterior decorticated bed of C_(1)-C_(2),and then was separated from the occipital bone with gelatin sponges.Occipital cervical instrumentation was removed to restore the occipital-cervical movement function after the atlantoaxial posterior fusion.Results Both patients underwent the operation successfully without complications of infection,internal fixation loosening or breakage.They were followed up for 18 and 16 months,and CT showed atlantoaxial bone graft fusion achieved around 5 and 6 months after the surgery respectively.Internal fixation were removed at 12 and 10 months postoperatively,and then two patients were followed up for more than 6 months,showing that cervical motion functions of flexion-extension and rotation were satisfied,and the reduction of atlantoaxial dislocation was maintained well without any neurological compression symptoms.Conclusion C0-C_(2)fixation and C_(1)-C_(2)posterior bone graft for fusion can provide a novel method for pediatric AAD with very lower ages.
作者
王建华
夏虹
马向阳
章凯
涂强
付索超
朱昌荣
尹庆水
WANG Jianhua;XIA Hong;MA Xiangyang;ZHANG Kai;TU Qiang;FU Suochao;ZHU Changrong;YIN Qingshui(Department of Orthopaedics,General Hospital of Southern Theatre Command,Guangzhou,Guangdong 510010,China)
出处
《中国骨科临床与基础研究杂志》
2020年第5期273-278,共6页
Chinese Orthopaedic Journal of Clinical and Basic Research
基金
军队医学科技青年培育计划孵化项目(19QNP040)
广州市科技计划项目(201904010349)
陆军军医大学军事类博士学位课题(JSKT201904)
军队后勤科研项目(CLB20J033)。
关键词
寰枢关节
脱位
脊柱融合术
骨移植
枕颈固定
儿童
Atlanto-axial joint
Dislocations
Spinal fusion
Bone transplantation
Occipital-cervical fixation
Child
