牵引治疗成人外伤性寰枢椎半脱位

目的:观察改良后的牵引疗法在成人外伤性寰枢椎半脱位中的应用。方法 :对2018年3月至2019年6月收治的31例寰枢椎半脱位患者进行回顾性分析,男15例,女16例;年龄18～68岁,平均39岁,其中18～40岁者10例,41～60岁者15例,51～68岁者6例。主要表现为颈部活动受限,疼痛,寰枢椎CT平扫示不同程度寰枢椎半脱位。运用三维多功能牵引床,牵引2 min,放松10 s,牵引角度以后伸位5°～10°,重量3～6 kg开始,每两天增加重量1 kg,至症状改善后,并以此重量维持治疗。牵引时间为30 min,每天牵引2次,10 d为1个疗程。寰枢椎间隙左右欠等宽1～2 mm者牵引1个疗程,3～4 mm者牵引2个疗程,特别疑难严重者如寰枢椎间隙左右欠等宽4 mm常规疗程无好转者,疗程可以增至3个月。治愈:颈部无疼痛,颈部活动正常范围,CT检查示寰枢椎间隙正常,齿突居中;治疗结束1个月后随访颈部活动正常者。好转:颈部疼痛明显好转,CT检查示寰枢椎间隙左右欠等宽1 mm者。结果:31例患者中,1个疗程治愈者17例;2个疗程治愈者11例,好转2例;3个月治愈者1例。结论:改良后的牵引疗法对成...     

儿童寰枢椎半脱位56例诊治与分析

目的 探讨和分析儿童寰枢椎半脱位的病因,解剖特点,发病机制,临床表现,诊断和治疗措施.方法 采用仰卧位枕颌带牵引,根据年龄体重调整牵引重量和牵引角度,配合药物及对症等治疗方法.所有患者在复查X线及CT片复位满意后,均根据患儿年龄选用合适的颈围外固定2～3个月.随后参照Mcienzie方法,行颈部康复锻炼.结果 本组56例经治疗后全部达到治疗标准的要求,复查X线片寰枢关节间隙全部恢复正常.出院后均经随访,时间为2～12个月,平均4.5个月,随访病例中有1例复发但未出现神经压迫症状.结论 早期诊断、早期治疗是提高疗效的关键.指导颈部康复功能锻炼,培养良好的生活习惯,亦能达到相辅相成、提高疗效、缩短疗程的目的.     

大重量牵引治疗寰枢椎脱位

头部和颈椎在遭受强的外力作用下 ,可发生急性寰枢椎脱位 ,使颈髓和延髓受压 ,引起致死性损伤。对因各种非外力性疾患所致的寰枢椎脱位 ,近年来也逐渐有所认识。按其脱位的方向 ,有向前脱位 ,向后脱位 ,旋转脱位 ,侧方脱位 (罕见 )及垂直脱位 (类风湿性关节炎患者较多 )。临床上所见大部分为向前脱位。目前治疗上对于无锥体束征者采用非手术治疗较多 ,我科采用手法整复 ,大重量牵引取得较好疗效 ,现报告如下 :1　临床资料1.1　一般资料我科 1995～ 2 0 0 1年共收治寰枢枢脱位患者 41例 ,均为住院患者 ,其中男2 5例 ,女 16例 ,10岁以下 3例 ,…     

小儿特发性寰枢椎半脱位

目的：探讨小儿特发性寰枢关节半脱位的发病机理及其治疗，评价X线平片、CT、MRI等检查在诊疗及康复过程的意义。方法：1991年2月～2000年3月问本院收治的286例小儿自发性寰枢椎半脱位病儿，仅作x线平片检查者212例，另74例因为各种原因还作CT或MRI检查确诊。全部患儿均给予颈托牵引治疗，其中16例加用地塞米松和甘露醇治疗。结果：平均住院12d，大部分治愈出院，出院后继续牵引1周巩固疗效。随访2～3年，11例有1～2次反复发生，及早牵引自愈。结论：分析发现195例患儿在颈托牵引治疗前后咽后壁软组织厚度的变化，与临床好转关系密切，因而对该病病因的深入认识提供了客观新线索。及早治疗见效快，颈托牵引治疗是最恰当的治疗方法。颈椎CT检查尤其是三维CT成像在该病的诊断中有重要意义，但由于价格原因使其在康复评价中受到限制。     

牵引正骨法治疗急慢性寰枢椎半脱位300例

近五年采用牵引、正骨方法，治疗急、慢性寰枢椎半脱位300例，报告如下。     

儿童陈旧性寰枢椎旋转半脱位的治疗选择

目的 探讨儿童陈旧性寰枢椎旋转半脱位的治疗方法.方法 自1998年3月～2007年6月收治23例陈旧性寰枢椎旋转半脱位患儿.确诊时间平均4.1个月.入院后予颅骨牵引,完全复位者行头颈胸石膏固定2个月.部分复位及复位后再脱位的行后路寰枢椎复位融合术.脱位无明显改善的行前路下颌下入路松解粘连后后路复位内固定.结果 Ⅰ型脱位5例中4例牵引复位其中1例再脱位;1例不能复位.Ⅱ型14例中9例牵引复位,其中6例再脱位;5例不能复位.Ⅲ型4例中1例牵引复位后再脱位;3例不能复位.随访显示23例斜颈畸形得到明显矫正,患儿没有明显的颈部疼痛.结论 大部分陈旧性脱位闭合复位困难,复位后再脱位发生率高需要手术治疗.手术复位融合寰枢椎治疗效果满意.     

小儿寰枢椎半脱位的早期诊治

目的 探讨小儿寰枢椎半脱位的早期诊治. 方法 对本组34例患者,均采用改良Glisson牵引,根据年龄体重调整牵引重量和牵引角度,配合药物及对症等治疗方法.2～3天后在牵引过程中拍片复查.之后维持牵引2周,并头颈胸行膏固定或者带上头颈胸支具2个月. 结果 所有34例患者经治疗后全部达到治疗标准的要求,复查X线片示寰枢椎关节已复位,寰椎两侧块与齿状突间距离相等并对称,寰椎前结节与齿状突间距离恢复正常(正常＜3mm),两侧块外缘与枢椎关节侧突外缘在一直线上.随访3～12个月,平均6个月,疗效满意.结论 早期诊断、早期治疗是关键,可以避免并发症和后遗症的出现.     

儿童自发性寰枢椎半脱位的诊断与治疗(附5例报告)

目的：分析儿童自发性寰枢椎半脱位的病因、临床表现及诊断与治疗。方法：回顾５例住院患儿的病史,阐述儿童自发性寰枢部位的临床表现及影像学诊断标准,着重分析早期诊断和正规的牵引治疗的重要性以及手术适应证和手术方法的选择。结果,５全名贵必均获随访,３例经颅骨牵引复位治疗,２例经手术治疗痊愈。结论：早期诊断及正规的牵引是治疗此症的关键。误仍及不正规的牵引往往延迟病情,给主实用性造成身心痛苦及经济负担。     

寰枢关节旋转半脱位的诊断进展

笔者就寰枢关节的解剖结构、病理改变、临床症状、X线投影作一综述，旨在对寰枢关节旋转半脱位作出明确诊断。     

手法治疗儿童寰枢关节半脱位21例

寰枢关节半脱位,好发于儿童及青壮年。中医治疗常以正骨手法为主,由于儿童发育不全或配合不佳,若处理不当,易发生高位截瘫等并发症。为了探寻最佳治疗方案,笔者近几年采用仰头摇正法治疗儿童寰枢关节半脱位21例,报告如下。1临床资料本组21例,男12例,女9例;年龄2～16岁,平均8.2岁。其中,有上呼吸道感染病史7例,外伤史(包括睡眠姿势不当)     

Traumatic atlantoaxial subluxation in children

We report four children who sustained traumatic atlantoaxial subluxation without a rotatory component, underlying congenital anomaly, or inflammatory cause. Three patients were involved in motor vehicle accidents as pedestrians, and one sustained a rugby injury to his neck. Only one patient sustained an associated head injury. Two patients had neurologic signs on admission directly attributable to the atlantoaxial subluxation. The signs resolved after reduction and stabilization of the subluxation. Three patients were treated conservatively and one operatively. To date, all four patients have had a satisfactory outcome.     

Pathomechanism of atlantoaxial rotatory fixation in children

The pathomechanism of atlantoaxial rotatory fixation (AARF) was studied using roentgenography and computerized tomography in affected children as well as cadaver studies of upper cervical spine anatomy. The increased incidence of AARF in children may be related to certain anatomical differences between children and adults. The dens-facet angle of the axis was steeper in children than in adults. Meniscus-like synovial folds were found in the C0/1 and C1/2 facet joints of the spines of children but not in those of adults.     

Reliability and necessity of dynamic computerized tomography in diagnosis of atlantoaxial rotatory subluxation

Dynamic computerized tomography (DCT) has been accepted to be the standard diagnostic method of atlantoaxial rotatory subluxation (AARS) although its reliability and reproducibility has not been shown yet. The purpose of this study was to evaluate the intraobserver reproducibility and interobserver reliability of DCT. Standard DCT scans of 18 patients with acute torticollis and 12 normal subjects were examined two times in between a time interval of 1 month by three specialists and a last-year resident to define any existing AARS. The interobserver reliability kappa coefficient was -0.015 (poor) for the first examination and 0.327(fair) for the second one. The intraobserver reproducibility kappa coefficients were 0.135 (slight), -0.204 (poor), 1.00 (almost perfect), and 0.474 (moderate) respectively. It was found that DCT has a poor reliability and reproducibility in diagnosing AARS in patients with acute torticollis. Therefore, its routine use is not cost effective in patients with acute torticollis where the deformity usually resolves by a simple cervical mobilization.     

The management of rotatory atlanto-axial subluxation in children

Twenty-three children who were treated for rotatory atlanto-axial subluxation between 1975 and 1986 were retrospectively studied. The success of closed reduction with traction and the length of hospitalization were related to the duration of symptoms before admission. In sixteen of the children, who were seen less than a month after the onset of symptoms, the subluxation reduced either spontaneously or after a short period of traction. Of the seven remaining children, who were seen more than one month after the onset of symptoms, three eventually needed a posterior atlanto-axial arthrodesis. Dynamic computed-tomography scans, with the head rotated maximally to each side, were made for five children, and proved to be an excellent method of documenting the presence of rotatory atlanto-axial subluxation.