Selby K A, Newton R W, Gupta S, Hunt L
Royal Manchester Children's Hospital.
Arch Dis Child. 1991 Jul;66(7):876-8. doi: 10.1136/adc.66.7.876.
Clinical signs and symptoms that might predict atlantoaxial subluxation were studied prospectively in 135 of 180 children with Down's syndrome aged 6-14 years who form the Hester Adrian Research Centre cohort. Lateral radiographs of the cervical spine were taken in flexed, extended, and neutral positions, and the percentage of abnormalities in each view was 14, 10, and 10%, respectively. Gait was the only significant clinical predictor. The relative risk of having an abnormal neck radiograph with an abnormal gait was 2.91 (95% confidence interval (CI) 1 to 8). The sensitivity was 50% and the specificity 81%. Nineteen children had repeat radiographs to assess the reliability of radiological diagnosis. Six had abnormalities; five of 19 (26%) had an abnormality on the first radiograph, and four of 19 (21%) had an abnormality on a second radiograph, but only three (15%) had an abnormality on both occasions in any view (95% CI 0 to 25). We conclude that radiographs of the cervical spine are unreliable at identifying atlantoaxial subluxation in children with Down's syndrome, and we failed to identify any reliable clinical predictor.
对海丝特·阿德里安研究中心队列中180名6至14岁唐氏综合征患儿中的135名进行了前瞻性研究，以探究可能预示寰枢椎半脱位的临床体征和症状。对颈椎进行了前屈、后伸和中立位的侧位X线片拍摄，每个体位的异常率分别为14%、10%和10%。步态是唯一显著的临床预测指标。步态异常的患儿颈椎X线片异常的相对风险为2.91（95%置信区间（CI）1至8）。敏感性为50%，特异性为81%。19名患儿进行了重复X线片检查以评估放射学诊断的可靠性。其中6名存在异常；19名患儿中有5名（26%）在第一张X线片上出现异常，19名患儿中有4名（21%）在第二张X线片上出现异常，但在任何体位下两次检查均出现异常的只有3名（15%）（95%CI 0至25）。我们得出结论，颈椎X线片在识别唐氏综合征患儿寰枢椎半脱位方面不可靠，并且我们未能识别出任何可靠的临床预测指标。
