Hirth K, Welkoborsky H-J
Klinik für Hals-Nasen-Ohrenheilkunde, Klinikum Hannover Nordstadt und HNO-Klinik, Kinderkrankenhaus "Auf der Bult", Hannover, Germany.
Laryngorhinootologie. 2003 Nov;82(11):794-8. doi: 10.1055/s-2003-44547.
Non-traumatic atlanto-axial subluxation is a rare complication of upper neck inflammatory processes and head and neck surgery. It is called Grisel's syndrome named after P. Grisel, who first described this condition in 1930. Persistent torticollis following head and neck surgery or upper respiratory tract infections should alert the surgeon to a beginning atlanto-axial subluxation. Due to lax ligaments it especially occurs in children and patients with Down's syndrome.
We present two cases of Grisel's syndrome in children following head and neck surgery with prolonged history, discussing pathogenesis, diagnostic measures and therapy.
Although there are several theories concerning the actual pathogenesis, it is generally agreed that an inflammatory process is the primary cause of Grisel's syndrome. Therefore, early antibiotic treatment is recommended. Further treatment depends on clinical findings and Fielding classification of the degree of the subluxation and includes muscle relaxations, soft collar or stiff neck, cervical traction or even arthrodesis of C1 and C2. If recognised early and appropriate treatment is applied, the prognosis is excellent. Severe cases can present with degenerative disorders of the cervical spine or even with neurological malfunction.
非创伤性寰枢椎半脱位是上颈部炎症性疾病及头颈外科手术的一种罕见并发症。它以P. Grisel的名字命名为Grisel综合征，P. Grisel于1930年首次描述了这种病症。头颈外科手术后或上呼吸道感染后持续存在斜颈应提醒外科医生警惕寰枢椎半脱位的发生。由于韧带松弛，这种情况尤其多见于儿童和唐氏综合征患者。
我们报告两例儿童头颈外科手术后发生的Grisel综合征，病史较长，并讨论其发病机制、诊断方法及治疗。
尽管关于实际发病机制有多种理论，但普遍认为炎症过程是Grisel综合征的主要病因。因此，建议早期使用抗生素治疗。进一步的治疗取决于临床检查结果及根据Fielding分类法对半脱位程度的评估，包括肌肉松弛、软颈托或硬颈围、颈椎牵引甚至C1和C2关节融合术。如果早期识别并采取适当治疗，预后良好。严重病例可能出现颈椎退行性病变甚至神经功能障碍。
