小儿枕—环—枢节段创伤合并延颈髓损伤的诊断和外科治疗

目的 探讨小儿枕-环-枢节段(Oc-C2)创伤合并延领颈髓损伤(M—CSCI)的诊断和外科治疗。方法 回顾38例2-10岁Oc-C2节段创伤合并延颈髓损伤病儿的诊断及治疗。分析合并颈延髓损伤的解剖和力学机制；经X线、CT及MRI证实Oc-C2节段创伤10岁以下病儿74例，其中合并延颈损伤38例；主要表现为颈延交界及上位颈髓受损症状。治疗：36例均经牵引复位、后路减压和枕颈融合手术，术后继续牵引2周，再行头环背心，颈托或头颈胸支具固定8-10周。结果 经9月至3年的随访，FrankelB级7例，4例恢复至C级，1例至D级，2例死亡；RrankelC级22例恢复正常15例，恢复至D级4例，无变化2例，1例失访，FrankelD级9例均恢复正常。结论 10岁以下儿童，以覆膜为主的各韧带在维持Oc-C2节段结构稳定性起着重要作用，而MRI对此类病儿的诊断具有决定价值，治疗上牵引复位、后路浅压及枕颈融合巳被广泛接受，公认为首选的治疗方案。

Diagnosis and therapy of occipitoatlantoaxial(Oc-C_2)trauma with medulla oblongata and upper cervical spinal cord injury(M-C SCI)in children

Objective To explore the diagnosis and therapy of occipitoatlantoaxial trauma with medullary and upper cervical spinal cord injury in children.Methods To analyse of the anatomy and mechanics mechanism through retrospecting diagnosis and therpy of Oc-C 2 trauma with M-C SCI in 38 children under 10 years of age.They mainly represented compressed and injured symptoms of medulla oblongata and upper cervical spinal cord.Treatment included:lasting traction for two weeks after tractive reduction,dorsal decompression and occipitocervical fusion.Then immobilization was continued for 8-10 weeks with halo vest,orthopaedic collar and orthosis.Results Followed up for 9 to 36 months(averaging 15 months),out of 7 cases in Frankel B grade,4 cases improved to C grade,1 cases to D grade,and 2 cases died.Out of 22 cases in Frankel C grade,15 cases became normal,4 cases improved to D grade,2 cases remained unchanged and 1 case was lost in follow-up.In Frankel D grade all the 9 cases became normal.Conclusion Among the internal ligaments,the tectorial membrane appears to play a critical role in Oc-C 2 stability for developing nature in these children.MRI determinatively contribute to diagnosis.Tractive reduction,posterior decompression and fusion are accepted and preferred widely.