Lee S C, Lui T N, Lee S T
Department of Neurosurgery, Chang Gung University & Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Br J Neurosurg. 2002 Apr;16(2):154-7. doi: 10.1080/02688690220131778.
Treatments of atlanto-axial rotatory subluxation in children are generally conservative. Previous reports have proposed that surgical treatment be reserved for fixed rotatory subluxation of more than 3 months duration, irreducible deformity or cases of recurrence. Six skeletally immature patients with Fielding type III atlanto-axial rotatory subluxation were treated conservatively with or without subsequent atlanto-axial arthrodesis. The follow-up period for all the cases exceeded 18 months. Results and outcomes were analysed with an emphasis on the delay until diagnosis, causes of delays in diagnosis and factors influencing the necessity of surgical intervention. Neither mortality nor major morbidity was noted in any cases in this study. In our experience, type III fixed rotatory subluxation of 6 weeks duration will potentially recur. We recommend early surgery for type III fixed rotatory subluxation of more than than 3 months' duration, with atlanto-axial arthrodesis being a safe and effective procedure in children.
儿童寰枢椎旋转性半脱位的治疗通常是保守的。既往报告提出，手术治疗应保留用于持续时间超过3个月的固定性旋转性半脱位、不可复位畸形或复发病例。6例骨骼未成熟的Fielding III型寰枢椎旋转性半脱位患者接受了保守治疗，部分患者随后进行了寰枢椎融合术。所有病例的随访期均超过18个月。对结果和转归进行了分析，重点关注诊断延迟情况、诊断延迟的原因以及影响手术干预必要性的因素。本研究中所有病例均未出现死亡或严重并发症。根据我们的经验，持续6周的III型固定性旋转性半脱位有潜在复发可能。我们建议，对于持续时间超过3个月的III型固定性旋转性半脱位应尽早进行手术，寰枢椎融合术对儿童来说是一种安全有效的手术方法。
