Aronson D D, Kahn R H, Canady A, Bollinger R O, Towbin R
Department of Orthopaedic Surgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit.
J Bone Joint Surg Am. 1991 Jul;73(6):898-906.
Stability of the cervical spine was studied in two groups of children who had myelomeningocele. Group I consisted of twenty children who had an Arnold-Chiari Type-II malformation in whom a suboccipital craniectomy (partial occipital craniectomy through the suboccipital route) and cervical laminectomy was done to decompress the brain stem. The average duration of follow-up in this group (excluding one patient) was 4.7 years (range, 2.3 to 10.4 years) after the operation. Group II consisted of twenty children who had myelomeningocele but had not had an operation for decompression. Lateral radiographs of the cervical spine in flexion and extension showed no instability between the occiput and atlas or between the atlas and axis in either group. In contrast, translation between the second and third cervical vertebrae averaged four millimeters in Group I and one millimeter in Group II (p less than 0.01), and angulation between the third and fourth cervical vertebrae averaged 17 degrees in Group I and 6 degrees in Group II (p less than 0.01). Nineteen of the twenty patients in whom a suboccipital craniectomy and cervical laminectomy (Group I) had been done had instability of the cervical spine.
对两组患有脊髓脊膜膨出的儿童的颈椎稳定性进行了研究。第一组由20名患有阿诺德-基亚里II型畸形的儿童组成，对他们进行了枕下颅骨切除术（通过枕下途径进行部分枕骨颅骨切除术）和颈椎椎板切除术以减压脑干。该组（不包括一名患者）术后的平均随访时间为4.7年（范围为2.3至10.4年）。第二组由20名患有脊髓脊膜膨出但未进行减压手术的儿童组成。颈椎屈伸位的侧位X线片显示，两组中枕骨与寰椎之间或寰椎与枢椎之间均无不稳定情况。相比之下，第一组第二和第三颈椎之间的平移平均为4毫米，第二组为1毫米（p<0.01），第一组第三和第四颈椎之间的成角平均为17度，第二组为6度（p<0.01）。在接受枕下颅骨切除术和颈椎椎板切除术的20名患者（第一组）中，有19名存在颈椎不稳定情况。
