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

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：回顾2006年2月至2019年2月8例急性Ⅰ型横韧带损伤致寰枢椎脱位学龄期儿童，男6例，女2例；年龄9～12岁；均为急性损伤，其中高位摔伤4例，车祸伤2例，运动伤2例；寰齿间距5～8 mm。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C_1，2角平均20.7°～23.4°。所有患儿接受颅骨牵引，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（space available for the cord，SAC）及颈椎功能障碍指数（neck disability index，NDI），寰齿间距，ASIA分级及C_1，2角的变化。结果：所有患儿获随访，时间8～156个月。临床和放射学随访显示，寰枢椎关节完全缓解，复位满意，关节融合稳定。未观察到与此技术相关的神经和血管损伤。术前患儿的JOA评分、SAC、NDI、C_1，2角与末次随访比较，均有明显改善。2例ASIA分级D级患儿恢复到E级。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。

Bilateral atlantoaxial lamina hook and atlantoaxial joint space screw for the treatment of acute type I transverse ligament injury in school-age children

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 to 12 years old;8 acute injuries included 4 high-level falls,2 car accidents and 2 sports injuries;the atlantoaxial interval(ADI) was 5 to 8 mm. Eight cases presented with pain,stiffness,numbness and cervical spine dysfunction in different degrees. Two of them were accompanied by nerve compression and ASIA grade D. The preoperative C_1,2 angle averaged 20.7° to 23.4°. All patients received cranial traction and surgical treatment after complete reduction or atlantoaxial reduction. 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 C_1,2 angle before and after treatment were observed.Results:The average follow-up time was 8 to 156 months. Clinical and radiological follow-up showed that the atlantoaxial joint was completely relieved,the reduction was satisfactory and the arthrodesis was stable. Nerve and vascular injuries associated with this technique were not observed. JOA score,SAC,NDI,C_1,2 angle of the last follow-up of the children were significantly improved. Two children of ASIA grade D recovered to grade E.Conclusion: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.