Tsirikos Athanasios I, Chang Wei-Ning, Shah Suken A, Miller Freeman
Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19899, USA.
J Pediatr Orthop. 2003 May-Jun;23(3):335-41.
The development of nontraumatic atlantoaxial instability in children with spastic cerebral palsy has not been reported. The authors present three patients with severe spastic quadriplegia who developed C1-C2 instability and cervical myelopathy at mean age 12.6 years. These patients demonstrated a similar clinical picture with symptoms attributed to cervical myelopathy in varied severity including apneic episodes, opisthotonus, alteration in muscle tone, torticollis, respiratory problems, hyperreflexia, and bradycardia. Patient 1 was scheduled for surgery but died due to an apneic episode. Patient 2 refused surgery and has been followed for 3 years while his neurologic condition remains unchanged. Patient 3 underwent occipitocervical decompression and fusion, recovered neurologically, and resumed his previous functional skills. Patients demonstrating considerable functional deterioration or insidious change in their established neurologic status should undergo detailed screening to rule out developing upper cervical instability. Early surgical intervention consisting of spinal decompression and fusion may prevent the development of myelopathy.
痉挛性脑瘫患儿非创伤性寰枢椎不稳的情况尚未见报道。作者报告了3例严重痉挛性四肢瘫患儿，他们在平均年龄12.6岁时出现C1-C2不稳和颈髓病。这些患者表现出相似的临床症状，归因于颈髓病的症状严重程度各异，包括呼吸暂停发作、角弓反张、肌张力改变、斜颈、呼吸问题、反射亢进和心动过缓。患者1原定进行手术，但因呼吸暂停发作死亡。患者2拒绝手术，已随访3年，其神经状况未变。患者3接受了枕颈减压融合术，神经功能恢复，恢复了之前的功能技能。表现出明显功能恶化或既定神经状态隐匿变化的患者应接受详细筛查，以排除上颈椎不稳的发生。包括脊柱减压和融合在内的早期手术干预可能预防脊髓病的发展。
