Pueschel S M, Scola F H
Child Development Center, Department of Pediatrics, Providence, RI 02902.
Pediatrics. 1987 Oct;80(4):555-60.
Atlantoaxial instability is a relatively frequent finding in individuals with Down syndrome. We examined 404 patients with this chromosome disorder and observed their atlanto-dens intervals and spinal canal widths to be significantly different from children without Down syndrome. Significant differences were also noted between boys and girls with Down syndrome in spinal canal widths but not in atlanto-dens interval measurements. When different neck positions were compared, measurements obtained in flexion were significantly greater than in extension or in neutral position. In addition, more patients had greater than or equal to 5 mm atlanto-dens interval measurements in flexion than in extension or neutral. A total of 59 (14.6%) of 404 patients displayed atlantoaxial instability. Fifty-three (13.1%) patients had asymptomatic atlantoaxial instability, and special precautions will have to be taken with this group of children. Six (1.5%) patients had symptomatic atlantoaxial instability who underwent surgery to prevent further injury to the spinal cord. In our follow-up studies of 95 patients with Down syndrome, we did not find any significant changes during either clinical or radiographic reexaminations.
寰枢椎不稳在唐氏综合征患者中是较为常见的表现。我们检查了404例患有这种染色体疾病的患者，发现他们的寰齿间距和椎管宽度与非唐氏综合征儿童有显著差异。唐氏综合征患儿中，男孩和女孩的椎管宽度也存在显著差异，但寰齿间距测量值无差异。比较不同颈部位置时，屈曲位测量值显著大于伸展位或中立位。此外，与伸展位或中立位相比，更多患者在屈曲位时寰齿间距测量值大于或等于5mm。404例患者中共有59例（14.6%）表现为寰枢椎不稳。53例（13.1%）患者有无症状性寰枢椎不稳，对于这组儿童必须采取特殊预防措施。6例（1.5%）患者有症状性寰枢椎不稳，接受了手术以防止脊髓进一步损伤。在我们对95例唐氏综合征患者的随访研究中发现，临床或影像学复查期间均未发现任何显著变化。
