Elliott S, Morton R E, Whitelaw R A
Department of Radiology, Derbyshire Royal Infirmary, Derby.
Arch Dis Child. 1988 Dec;63(12):1484-9. doi: 10.1136/adc.63.12.1484.
Radiography of the lateral neck was performed on all children with Down's syndrome aged 4-15 in the Southern Derbyshire health district (n = 67) and a random selection of adults (n = 94). Atlantoaxial instability, defined as a gap of over 4 mm, was present in seven (10%) children and two (2%) adults. Odontoid hypoplasia, defined as an odontoid peg two standard deviations below the mean in an age matched population, was present in 15 (22%) children and 14 (15%) adults, with accessory odontoid ossicles present in two (2%) and two (3%) respectively. No one was found to have symptoms or clinical signs of spinal cord compression. Atlantoaxial instability was therefore found to be commoner in children than adults. Different programmes of management are suggested, in terms of regular clinical examination for signs and symptoms and by radiographic screening. Particular care should be taken with those who have both atlantoaxial instability and odontoid hypoplasia or accessory ossicles as they are at particular risk of spinal cord damage.
对南德比郡健康区所有4至15岁的唐氏综合征儿童（n = 67）以及随机抽取的成年人（n = 94）进行了颈部侧位X线摄影。寰枢椎不稳定定义为间隙超过4毫米，7名（10%）儿童和2名（2%）成年人存在该情况。齿状突发育不全定义为在年龄匹配人群中齿状突低于均值两个标准差，15名（22%）儿童和14名（15%）成年人存在该情况，分别有2名（2%）儿童和2名（3%）成年人有附属齿状突小骨。未发现有人有脊髓受压的症状或体征。因此发现寰枢椎不稳定在儿童中比在成年人中更常见。就定期进行体征和症状的临床检查以及通过X线筛查而言，建议采用不同的管理方案。对于同时患有寰枢椎不稳定和齿状突发育不全或附属小骨的人应格外小心，因为他们有脊髓损伤的特殊风险。
