Cohen M W, Drummond D S, Flynn J M, Pill S G, Dormans J P
Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
Spine (Phila Pa 1976). 2001 Apr 1;26(7):825-9. doi: 10.1097/00007632-200104010-00026.
Description of an operative technique with an illustrative case report.
The technique is presented to provide an alternative to iliac crest graft procedures for achieving occipitocervical fusion in children. This technique is particularly useful in children with instability after extensive decompression or laminectomy and in children with a large protuberant occiput.
The majority of techniques previously described for occipitocervical fusion in children rely on corticocancellous iliac crest autograft. Results generally have been promising; however, it can be difficult to harvest enough graft to span large defects after extensive decompression or to contour an iliac crest graft to a protuberant occiput. Structural rib autograft is superior in terms of availability and its unique and modifiable contour. Theoretical benefits of rib graft include superior strength and lower donor site morbidity.
The surgical technique is described. A case of a 2-year-old boy with Down's syndrome and myelopathy secondary to cervical instability is reviewed.
The patient underwent occipitocervical arthrodesis using the technique described. The child made a full neurologic recovery, and at the 2-years follow-up evaluation, the graft had incorporated and the spine was stable.
A technique of occipitocervical arthrodesis in children is described using autologous rib graft. This procedure was designed to span large defects or to deal with a large protuberant occiput; however, it is also useful for less demanding cases and may offer several advantages compared with procedures relying on iliac crest graft.
通过一个病例报告描述一种手术技术。
介绍该技术，为儿童枕颈融合提供一种替代髂嵴植骨手术的方法。该技术对于广泛减压或椎板切除术后不稳定的儿童以及枕部突出较大的儿童尤为有用。
先前描述的大多数儿童枕颈融合技术依赖于髂骨皮质松质自体骨移植。结果总体上很有前景；然而，在广泛减压后，可能难以获取足够的移植骨来跨越较大的缺损，或者难以将髂嵴移植骨塑形以适应突出的枕部。结构性肋骨自体骨移植在可用性及其独特且可修改的外形方面更具优势。肋骨移植的理论优势包括强度更高和供区并发症更低。
描述了手术技术。回顾了一例患有唐氏综合征且因颈椎不稳定继发脊髓病的2岁男孩的病例。
该患者采用所述技术进行了枕颈关节融合术。患儿神经功能完全恢复，在2年的随访评估中，移植骨已融合，脊柱稳定。
描述了一种使用自体肋骨移植进行儿童枕颈关节融合术的技术。该手术旨在跨越较大的缺损或处理枕部突出较大的情况；然而，它对于要求较低的病例也很有用，并且与依赖髂嵴移植的手术相比可能具有多个优势。
