Herrada-Pineda Tenoch, Loyo-Varela Mauro, Revilla-Pacheco Francisco, Uribe-Leitz Monika, Manrique-Guzmán Salvador
Departamento de Neurocirugía Pediátrica, Centro Médico ABC, México, D.F., México.
Departamento de Neurocirugía, Centro Médico ABC, México, D.F., México.
Cir Cir. 2015 Mar-Apr;83(2):135-40. doi: 10.1016/j.circir.2015.04.009. Epub 2015 May 16.
Cranieovertebral junction lesions in the paediatric population are associated with a low survival rate, which has declined in recent years. Neurological disability is a major concern due to the high economical cost it represents. Paediatric patients are more susceptible to this lesion because of hyperextension capacity, flat articulation, and increased ligamentous laxity. Survival after these kinds of injuries has been more often reported in adults, but are limited in the paediatric population.
A case is reported of an 8-year-old male with occipitocervical and atlantoaxial dislocation associated with clivus fracture, brain oedema, and post-traumatic subarachnoid haemorrhage (SAH). A halo vest system was placed with no traction. One month after the trauma the patient was surgically treated with C1 and C2 trans-articular screws, occipitocervical fixation with plate and screws, and C1- C2 fixation with tricortical bone graft and wires without complication. He has now returned to school and is self-sufficient.
With better pre-hospital medical care and with improved surgical techniques the mortality rate has declined in this kind of lesion.
儿科人群的颅颈交界区病变与低生存率相关，近年来生存率有所下降。由于神经功能障碍带来的高昂经济成本，它成为一个主要问题。儿科患者因伸展能力过强、关节扁平以及韧带松弛增加而更容易出现这种病变。这类损伤后的生存情况在成人中报道较多，但在儿科人群中有限。
报告了一例8岁男性患者，伴有枕颈和寰枢椎脱位，合并斜坡骨折、脑水肿和创伤后蛛网膜下腔出血（SAH）。未进行牵引，直接安置了头环背心固定系统。创伤后1个月，患者接受手术治疗，采用C1和C2经关节螺钉、枕颈钢板螺钉固定以及C1 - C2三皮质骨移植和钢丝固定，无并发症发生。他现已重返学校，生活自理。
随着院前医疗护理的改善和手术技术的提高，这类病变的死亡率有所下降。
