Hwang Steven W, Gressot Loyola V, Chern Joshua J, Relyea Katherine, Jea Andrew
Pediatric Neuro-Spine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
J Neurosurg Pediatr. 2012 Jun;9(6):586-93. doi: 10.3171/2012.2.PEDS11497.
Occipitocervical stabilization in the pediatric age group remains a challenge because of the regional anatomy, poor occipital bone purchase, and, in some instances, significant thinning of the occipital bone. Multiple bicortical fixation points to the occipital bone may be required to increase construct rigidity. The authors evaluated the complications of bicortical occipital screw placement in children with occipital fusion constructs.
The records of 20 consecutive pediatric patients who had undergone occipitocervical fusion between September 1, 2007, and November 30, 2010, at Texas Children's Hospital were reviewed.
The patients consisted of 10 girls and 10 boys, ranging in age from 10 months to 16 years (mean ± SD, 7.7 ± 5.1 years). Two patients were lost to follow-up, 2 died for reasons unrelated to the surgery, and the remaining patients had at least 3 months of follow-up (mean 14 ± 11.8 months) with evaluation via dynamic radiography and CT. Four patients experienced 8 complications: 2 CSF leaks, 2 vigorous venous bleedings, worsening of quadriparesis, wound infection, radiographic pseudarthrosis, and transient dysphagia. Among 114 screws, there were 2 cases of intraoperative dural venous sinus injury and 2 cases of intraoperative CSF leakage, without clinical sequelae from these complications. Only 1 case of radiographic pseudarthrosis was identified in a patient with skeletal dysplasia and a prior failed C1-2 posterior arthrodesis. There were no difficulties with wound healing because of prominent occipital instrumentation, and there was only 1 wound infection.
Data in this report confirm that including bicortical occipital screw placement in occipitocervical constructs in children may result in a high fusion rate but at the cost of a notable complication rate.
由于该区域的解剖结构、枕骨固定不佳，以及在某些情况下枕骨显著变薄，小儿年龄组的枕颈稳定术仍然是一项挑战。可能需要多个枕骨双皮质固定点来增加结构的刚性。作者评估了在接受枕颈融合结构治疗的儿童中进行枕骨双皮质螺钉置入的并发症。
回顾了2007年9月1日至2010年11月30日在德克萨斯儿童医院接受枕颈融合术的20例连续儿科患者的记录。
患者包括10名女孩和10名男孩，年龄从10个月至16岁（平均±标准差，7.7±5.1岁）。2例患者失访，2例因与手术无关的原因死亡，其余患者至少随访3个月（平均14±11.8个月），通过动态X线摄影和CT进行评估。4例患者出现8种并发症：2例脑脊液漏、2例剧烈静脉出血、四肢瘫加重、伤口感染、影像学假关节形成和短暂性吞咽困难。在114枚螺钉中，有2例术中硬脑膜静脉窦损伤和2例术中脑脊液漏，这些并发症均无临床后遗症。仅在1例患有骨骼发育异常且先前C1-2后路关节融合术失败的患者中发现1例影像学假关节形成。没有因枕骨器械突出而导致伤口愈合困难的情况，仅有1例伤口感染。
本报告中的数据证实，在儿童枕颈结构中采用枕骨双皮质螺钉置入可能会导致较高的融合率，但代价是显著的并发症发生率。
