Center for Spine Surgery, Orthopedics and Traumatology, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany.
Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2021 Jan;82(1):1-8. doi: 10.1055/s-0040-1712940. Epub 2020 Sep 23.
The atlantoaxial joint represents the most mobile joint complex within the spine, secured by ligaments and capsules. Integrity of the atlantoaxial joint is crucial with respect to the mobility of the head and the upper spine. Atlantoaxial rotatory dislocation is the most common type of injury within this joint in children and is characterized by a typical position of the head (cock robin position). Nevertheless, this type of injury is frequently overlooked. The purpose of the current study was threefold. First, the characteristics of the patients with atlantoaxial dislocation were identified. Next, we checked if the time to treatment did influence the type of treatment. Finally, we checked if the age of the child at the time of treatment influenced the type of treatment.
Forty-four children, who were treated consecutively due to atlantoaxial dislocation at a single spine center between September 1993 and October 2018, are analyzed retrospectively regarding age, sex, symptoms, etiology, time to diagnosis, time to treatment, and outcome.
Forty-four children (30 girls, mean age 8.9 years) were included in the study. The cock robin head position was found in all of them, but neurological deficits were not found in any of them. In 21 patients, dislocation was caused by previous infection (Grisel's syndrome), whereas in 19 patients, dislocation was due to minor trauma. In 4 cases, etiology remained unknown. Mean time to sufficient treatment was 178 days. Eighteen patients received closed reduction and immobilization after 57 days at mean. Open reduction followed by temporary fixation was done in 12 patients after a mean time gap of 188 days. Bony atlantoaxial fusion was necessary in 14 children, who were diagnosed after 319 days on average. Invasiveness of treatment was dependent on the time delay between development of dislocation and treatment; a significant difference was found between invasiveness of treatment and time to treatment (Kruskal-Wallis test, < 0,05). Moreover, older children were treated significantly more often with fusion than younger ones ( , = 0,002).
Young girls are predisposed to incur an atlantoaxial rotatory dislocation, which usually occurs due to minor trauma or infection. The cock robin position is characteristic, but neurological deficits are not common. There is a need for early and sufficient treatment because delayed treatment necessitates more invasive treatment, thus leading to a complete loss of function of the most mobile joint within the spine. Finally, older children are predisposed to more invasive treatment strategies.
寰枢关节是脊柱中最灵活的关节复合体，由韧带和囊固定。寰枢关节的完整性对于头部和上脊柱的活动至关重要。寰枢旋转脱位是儿童中最常见的关节损伤类型，其特征是头部的典型位置（鸡冠状头位）。然而，这种类型的损伤经常被忽视。本研究的目的有三。首先，确定寰枢关节脱位患者的特征。其次，检查治疗时间是否会影响治疗类型。最后，检查治疗时儿童的年龄是否会影响治疗类型。
回顾性分析 1993 年 9 月至 2018 年 10 月在一家脊柱中心因寰枢关节脱位连续治疗的 44 例儿童的年龄、性别、症状、病因、诊断时间、治疗时间和结果。
44 例儿童（30 例女孩，平均年龄 8.9 岁）纳入研究。所有患者均出现鸡冠状头位，但均无神经功能缺损。21 例患者由先前感染（Grisel 综合征）引起脱位，19 例患者由轻微创伤引起脱位。4 例病因不明。平均充分治疗时间为 178 天。18 例患者在平均 57 天后接受闭合复位和固定。12 例患者在平均 188 天后行切开复位及临时固定。14 例儿童平均诊断后 319 天需要进行骨性寰枢融合。治疗的侵袭性与脱位发展与治疗之间的时间延迟有关；治疗时间与治疗侵袭性之间存在显著差异（Kruskal-Wallis 检验，<0.05）。此外，年龄较大的儿童比年龄较小的儿童更常接受融合治疗（χ2检验，=0.002）。
年轻女孩易发生寰枢旋转脱位，通常由轻微创伤或感染引起。鸡冠状头位是特征性的，但不常见神经功能缺损。需要早期和充分的治疗，因为延迟治疗需要更具侵袭性的治疗，从而导致脊柱中最灵活关节的完全丧失功能。最后，年龄较大的儿童更倾向于采用侵袭性治疗策略。
