儿童上颈椎畸形及不稳的手术治疗远期疗效评价

目的评价儿童枕颈部发育畸形早期临床特点和评价10年以上的远期手术治疗效果.方法回顾42例儿童枕颈畸形诊断要点及经手术减压和寰枢椎、枕颈融合术对脊髓功能、稳定功能、枕颈部发育的影响,并观察远期治疗效果.结果(1)枕颈和寰枢椎植骨均获坚强骨性融合;(2)37例术前神经功能障碍,33例完全恢复,2例神经根刺激症,2例仍有轻微脊髓压迫症状;(3)38例术后长达10年以上未发生枕颈发育障碍,4例发育后出现轻度畸形,其中1例轻度后伸,3例枕颈前屈.结论儿童枕颈部发育畸形早期作出诊断,在无脱位和明显脊髓压迫症出现之前手术稳定,对防止加重脊髓功能障碍有重要作用,并对其生长发育无明显影响.

Long-term Results of Surgical Treatment for Upper Cervical Spine Malformation and Instability in Children

Objective: To evaluate the early clinical characteristic and the long term results of surgical treatment for upper cervical spine malformation and instability in children. Methods: The diagnostic measure, the effects of surgical decompression and occipitocervical fusion or atlanto axis arthrodesis on the spinal cord function, stability, and the development of the occipital atlanto axis region of 42 cases of upper cervical spine malformation and instability in children were reviewed. Results: Bony unions were obtained in both with occipitocervical fusion and atlanto axis arthrodesis. In 37 cases with neurological dysfunction pre operation, 33 cases recovered completely, while 2 cases remained radiculopathies and another 2 cases remained slight symptoms of spinal cord compression. In all cases, no secondary occipitocervical deformation occurred in 38 cases, while slight deformation occurred in 4 cases, of which 1 case revealed slightly kyphosis deformation and 3 flexion deformation. Conclusion: It is important to take an early diagnosis and to make a stable operation before dislocation and obvious spinal cord compression had happened for preventing children's occipitocervical malformation from severe neurological dysfunction. The arthrodesis operation had few effects on the development of the occipitocervical region.