儿童寰枢椎半脱位38例临床分析

目的：探讨儿童寰枢椎半脱位的发病机理、临床表现、诊断标准、手法治疗机理和疗效。方法：回顾性整理该病38例临床资料,包括性别、年龄、多发时间、病因、病程、症状和体征、影像学改变、治疗方法、治疗结果。并对这些资料进行分析。结果：大部分（78.9%）儿童起因于上呼吸道感染,急性扁桃腺炎和头颈部外伤。38例患者均有枢椎棘突偏歪,具有诊断学意义的影像学表现为：颈椎正位（开口位）、侧位片中的ADI≥3.0mm,齿状突偏歪,颈1、2顺列不良,寰枢椎外侧关节面不平行,咽后壁厚度≥4mm,颈椎曲度变直或反向,寰椎后结节上或下翘,咽后壁与颈4椎体矢状径比值〉0.3,寰枢棘突角≥10°,喉室壁与颈4椎体矢状径比值〉0.7。本文中冯氏手法治疗本病的有效率为100%。结论：儿童头颈部扭伤,咽喉与口腔部炎症和上呼吸道感染是本症最主要的发病原因,X线检查必须和症状体征结合才可作出诊断,冯氏手法是治疗该症的有效方法之一。

Clinical Study of 38 Cases with Atlantoaxial Subluxation in Children

Objective：To study the pathogenic mechanism, clinical manifestation, diagnostic criteria, treatment mechanism and therapeutic effect of atlantoaxial subluxation in children. Methods： The clinical documents of 38 patients with atlantoaxial subluxation were retrospectively analyzed, Before receiving Feng＇s spinal manipulation （FSM） treatment, the deviation directions of axial spinous process were assured by special palpation, Meanwhile, all patients took X-ray examinations in A-P （open mouth） and lateral view on cervical spine and data related to diagnosis criteria were measured. Results： Most of the cases （78.9%） had the history of upper respiratory tract infection, acute tonsillitis, injury of head and neck before the dislocation, and all patients had deviated axial spinous process. According to X--ray photographs in A--P （open mouth） and lateral view on cervical spine, ADI≥3, 0 mm, with deviated axial dens, abnormal sequence of C1-2, unparallel atlantoaxial outer articular facets, thickness of retropharyngeal space≥4 mm, cervical vertebrae curvature straight or reversed, posterior tubercle of atlas upward or downward, ratio of thickness of retropharyngeal space to sagittal diameter of C4 corpus vertebrae〉0.3, angulation of atlantoaxial spinous process≥10°, and ratio of thickness of larynx posterior space to sagittal diameter of C4 corpus vertebrae〉0.7. These data had high diagnostic value. The effective rate of manipulation treatment for the atlantoaxial subluxation in 38 children was 100%. Conclusion：The inflammation of head and neck and infection of upper respiratory tract were the major causes of dislocation. X--ray examination must be connected with clinics to make a correct diagnosis. The FSM is one of the effective therapies in treating atlantoaxial subluxation.