Arkader Alexandre, Hosalkar Harish S, Drummond Denis S, Dormans John P
Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J Child Orthop. 2007 Dec;1(6):337-44. doi: 10.1007/s11832-007-0065-x. Epub 2007 Nov 22.
To evaluate the safety and efficacy of halo immobilization in children younger than 3 years.
All children less than 3 years of age who were placed in a halo-orthosis at a tertiary pediatric center were reviewed to determine the indications, safety, and efficacy of this method. Adequacy of immobilization and correct technique was established considering the chronology of maturation (skull and brain development). The functional outcome was analyzed.
Ten patients (<3 years old) were identified from a total of 150 where halo ring/vest immobilization was used. There were six boys and four girls, with an average age of 2 years (range 10 months to 2 years and 10 months). The average time of immobilization in the halo-orthosis was 75 days (range 33-168 days), and the average follow-up time was 5 years and 2 months (range 1-12 years). There were two halo-related problems and four related to the index procedure. Halo-related problems included pin-site infection in one patient, and three pins loosening in another. There were four complications associated with the index procedure, all early in the series, including three cases of pseudarthrosis and one patient that had an insufficient decompression of basilar invagination. Two of the three failed fusions occurred at the occipito-cervical junction, which prompted us to develop new techniques for fusion at this level.
Halo-orthosis is a relatively safe and reliable device for immobilization of the upper cervical spine in children less than 3 years old. Understanding the developmental anatomy and a limited CT scan are helpful in pin placement. We recommend the use of a multiple pin construct, perpendicular insertion, and precise tightening with good pin-site care and frequent follow-up. The benefits seem to outweigh the risks in this population, considering the mechanical advantages of the halo-orthosis.
评估3岁以下儿童使用头环固定的安全性和有效性。
回顾性分析在一家三级儿科中心接受头环支具固定的所有3岁以下儿童，以确定该方法的适应证、安全性和有效性。根据成熟度（颅骨和脑发育）确定固定的充分性和正确技术，并分析功能结局。
在总共150例使用头环/背心固定的患者中，确定了10例（<3岁）患者。其中6名男孩，4名女孩，平均年龄2岁（范围10个月至2岁10个月）。头环支具的平均固定时间为75天（范围33 - 168天），平均随访时间为5年2个月（范围1 - 12年）。有2个头环相关问题和4个与索引手术相关的问题。头环相关问题包括1例患者的针道感染和另1例患者的3根针松动。与索引手术相关的并发症有4例，均发生在该系列的早期，包括3例假关节形成和1例基底凹陷减压不足的患者。3例融合失败中有2例发生在枕颈交界处，这促使我们开发该水平融合的新技术。
头环支具是3岁以下儿童上颈椎固定相对安全可靠的装置。了解发育解剖结构和有限的CT扫描有助于针的置入。我们建议使用多针结构、垂直插入，并精确拧紧，同时做好针道护理和频繁随访。考虑到头环支具的机械优势，在这一人群中似乎益处大于风险。
