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[克利佩尔-费尔常染色体显性综合征:一种椎体节段性畸形]

[Klippel-Feil autosomal dominant syndrome: A malformation of vertebral segmentation].

作者信息

Guapi Nauñay Víctor Hugo, Martínez Carvajal Iván Alejandro

机构信息

servicio de Neonatología, Hospital Provincial General "Luis G. Dávila", Tulcán, Ecuador.

Hospital Provincial General "Luis G. Dávila", Tulcán, Ecuador.

出版信息

Rev Chil Pediatr. 2019 Apr;90(2):194-201. doi: 10.32641/rchped.v90i2.779.

Abstract

INTRODUCTION

Klippel-Feil syndrome is a highly heterogeneous complex skeletal disorder characterized by the con genital fusion of two or more cervical vertebrae. The classic clinical triad consists of a short neck, low hairline, and neck movements limitation. The associated mutations are located in the loci of the GDF3 gene (chromosome 12p13.31), GDF6 (chromosome 8q22.1), and MEOX1 (chromosome 17q21.31).

OBJECTIVE

To describe the clinical-radiological findings and pedigree of a patient with Klippel-Feil syndrome.

CLINICAL CASE

A 5-year-old patient with short neck, low posterior hairline, and limitation of lateral movements. The cervical flexion and extension radiographs showed fusion blocks between C1-2-3, C4-5, and C6-7. The chest CT scan showed multiple hemivertebrae in the upper third of the thoracic vertebrae corresponding to ribs I-IV. The karyotype was normal, 46, XX. Reduced penetrance was present in five of the family members. The fusion of C2-3 was present in four members and one individual had low fusion in C5-6. Three of the five affected individuals had a fusion between the capitate and the hamate bone.

CONCLUSION

The malformation of congenital vertebral segmentation is a case of interest since it is an uncommon diagnosis in the pediatric age and whose clinical suspicion can be generated from the clinical examination, radiological study com plemented with the pedigree interpretation in Mendelian inheritance disorders, allowing to provide opportunely genetic counseling to the family.

摘要

引言

克-费综合征是一种高度异质性的复杂骨骼疾病,其特征为两个或更多颈椎先天性融合。典型的临床三联征包括短颈、低发际线和颈部活动受限。相关突变位于生长分化因子3基因(12号染色体p13.31)、生长分化因子6(8号染色体q22.1)和MEOX1(17号染色体q21.31)的基因座上。

目的

描述一例克-费综合征患者的临床-放射学表现及家系情况。

临床病例

一名5岁患者,有短颈、后发际线低及侧向活动受限。颈椎屈伸位X线片显示C1-2-3、C4-5和C6-7之间有融合块。胸部CT扫描显示胸椎上三分之一处对应第I-IV肋骨有多个半椎体。核型正常,46, XX。家系中有五名成员存在外显率降低的情况。四名成员存在C2-3融合,一名个体C5-6有低位融合。五名受累个体中有三名头状骨和钩骨之间存在融合。

结论

先天性椎体节段畸形是一个值得关注的病例,因为它在儿童期是一种罕见的诊断,通过临床检查、放射学研究并结合孟德尔遗传疾病的家系解读可引发临床怀疑,从而能够及时为家庭提供遗传咨询。

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