Huang Meng, Gonda David D, Briceño Valentina, Lam Sandi K, Luerssen Thomas G, Jea Andrew
Neuro-Spine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
Neurosurg Focus. 2015 Apr;38(4):E13. doi: 10.3171/2015.1.FOCUS14810.
Upper airway obstruction resulting from overflexion of the craniocervical junction after occipitocervical fusion is a rare but potentially life-threatening complication and is associated with morbidity. The authors retrospectively reviewed the medical records and diagnostic images of 2 pediatric patients who underwent occipitocervical fusion by the Neuro-Spine Program at Texas Children's Hospital and experienced dyspnea and/or dysphagia from new upper airway obstruction in the postoperative period. Patient demographics, operative data, and preoperative and postoperative occiput-C2 angles were recorded. A review of the literature for similar complications after occipitocervical fusion was performed. A total of 13 cases of prolonged upper airway obstruction after occipitocervical fusion were analyzed. Most of these cases involved adults with rheumatoid arthritis. To the best of the authors' knowledge, there have been no previous reports of prolonged upper airway obstruction in children after an occipitocervical fusion. Fixation of the neck in increased flexion (-18° to -5°) was a common finding among these adult and pediatric cases. The authors' cases involved children with micrognathia and comparatively large tongues, which may predispose the oropharynx to obstruction with even the slightest amount of increased flexion. Close attention to a satisfactory fixation angle (occiput-C2 angle) is necessary to avoid airway obstruction after an occipitocervical fusion. Children with micrognathia are particularly sensitive to changes in flexion at the craniocervical junction after occipitocervical fixation.
枕颈融合术后颅颈交界处过度屈曲导致的上气道梗阻是一种罕见但可能危及生命的并发症，且与发病率相关。作者回顾性分析了2例在德克萨斯儿童医院神经脊柱项目接受枕颈融合术的儿科患者的病历和诊断影像，这2例患者在术后出现了因新发上气道梗阻导致的呼吸困难和/或吞咽困难。记录了患者的人口统计学资料、手术数据以及术前和术后的枕骨 - C2角。对枕颈融合术后类似并发症的文献进行了回顾。共分析了13例枕颈融合术后出现长期上气道梗阻的病例。这些病例大多涉及患有类风湿关节炎的成年人。据作者所知，此前尚无儿童枕颈融合术后出现长期上气道梗阻的报道。在这些成人和儿科病例中，常见的情况是颈部固定于增加的屈曲位（-18°至 -5°）。作者的病例涉及小颌畸形和舌头相对较大的儿童，这可能使口咽即使在最轻微的屈曲增加时也易发生梗阻。枕颈融合术后需密切关注满意的固定角度（枕骨 - C2角）以避免气道梗阻。小颌畸形儿童在枕颈固定后对颅颈交界处屈曲的变化尤为敏感。
