Department of Neurosurgery, Ochsner Medical Center, New Orleans, Louisiana.
Department of Neurosurgery, Gwinnett Medical Center, Lawrenceville, Georgia.
Spine (Phila Pa 1976). 2019 Jan 1;44(1):17-24. doi: 10.1097/BRS.0000000000002741.
Retrospective review.
Evaluate radiographic and clinical outcomes for infants and children, who underwent rigid occipito-cervical fixation for traumatic craniocervical dissociation (tCCD).
Traumatic craniocervical dissociation is devastating. Children are at high risk but make up a large number of survivors. Non-rigid fixation has traditionally been favored over screw and rod constructs due to inherent challenges involved with instrumenting the pediatric craniocervical junction. Therefore, outcomes for rigid occipito-cervical instrumentation in infants and young children with tCCD remain uncertain.
Retrospective review of children who survived tCCD between 2006 and 2016 and underwent rigid occipito-cervical fixation.
Fifteen children, from 8 months to 8 years old (mean, 3.8 yr), were either a passenger (n = 11) or a pedestrian (n = 4) in a motor vehicle accident. Seven patients had weakness: five with quadriplegia, one with hemiparesis, and one with bilateral upper extremity paresis. Ten patients had concurrent C1-2 instability. At last follow-up, four patients had improved motor function: one with bilateral upper extremity paresis and one with hemiparesis regained full strength, one with quadriplegia regained function on one side while another regained function in bilateral upper extremities. All underwent rigid posterior occipito-cervical fixation, with two patients requiring additional anterior and posterior fixation at non-contiguous levels. Fourteen patients were stable on flexion-extension x-rays at a mean follow-up of 31 months (9-1 yr or longer, 7-2 yr or longer). There were no cases of deformity, growth disturbance, or subaxial instability.
Children who survive tCCD may regain function after stabilization. Rigid internal rod and screw fixation in infants and young children safely provided long-term stability. We advocate using C2 translaminar screws to exploit the favorable anatomy of pediatric lamina to minimize the risks of occipitocervical (OC) instrumentation.
回顾性研究。
评估因创伤性颅颈分离（tCCD）而行硬性枕颈固定的婴儿和儿童的影像学和临床结果。
创伤性颅颈分离是毁灭性的。儿童风险较高，但幸存者人数众多。由于儿童颅颈交界处的器械操作存在固有挑战，传统上不赞成使用刚性固定而赞成使用非刚性固定。因此，tCCD 婴儿和幼儿使用硬性枕颈器械的结果仍不确定。
对 2006 年至 2016 年间幸存 tCCD 并接受硬性枕颈固定的儿童进行回顾性研究。
15 名儿童（8 个月至 8 岁，平均 3.8 岁）均为机动车事故中的乘客（n=11）或行人（n=4）。7 例患者有无力：5 例四肢瘫痪，1 例偏瘫，1 例双侧上肢无力。10 例患者并发 C1-2 不稳定。末次随访时，4 例患者运动功能改善：1 例双侧上肢无力，1 例偏瘫恢复完全肌力，1 例四肢瘫痪恢复单侧功能，另 1 例恢复双侧上肢功能。所有患者均行硬性后路枕颈固定，2 例患者需要在非连续水平行前路和后路固定。14 例患者在平均随访 31 个月（9-1 年或更长，7-2 年或更长）时屈伸位 X 线片稳定。无畸形、生长障碍或下颈椎不稳定。
tCCD 幸存者经稳定后可能恢复功能。在婴儿和幼儿中使用刚性内棒和螺钉固定可安全提供长期稳定性。我们主张使用 C2 经椎板螺钉，以利用儿科椎板的有利解剖结构，最大限度地降低 OC 器械的风险。
4。
