Liu Hu,Guo Dong,Zhang Xuejun,et al.Posterior screw-plate system fixation and fusion atlantoaxial instability and dislocation in children[J].Journal of Clinical Pediatric Surgery,,22():1029-1033.[doi:10.3760/cma.j.cn101785-202307012-005]
Posterior screw-plate system fixation and fusion atlantoaxial instability and dislocation in children
- Keywords:
- Atlanto-Axial Joint; Dislocations; Congenital Abnormalities; Surgical Procedures; Operative; Child
- Abstract:
- Objective To evaluate the efficacy of posterior atlantoaxial screw-plate fixation and autologous bone graft fusion for atlantoaxial instability and dislocation in children.Methods From March 2019 to October 2022,22 children with atlantoaxial instability and dislocation were retrospectively reviewed.There were 12 boys and 10 girls with an age range of (8.2±2.8)(4-14) year.Degree and improvement of spinal cord injury before and after surgery were assessed by the neurological grading system of American Spinal Cord Injury Association (ASIA).Atlantodens interval (ADI) and clivus-axial angle (CAA) were measured for evaluating the reduction of atlas and axis.Space available for spinal cord (SAC) was measured for evaluating spinal cord compression.And ASIA impairment scale,bone graft fusion and complications were recorded.Results One-stage posterior atlantoaxial screw-plate fixation (n=20) and posterior reduction plus fusion after anterior release (n=2) were performed.The average follow-up period was (45.8±14.5)(13-48) month.No intraoperative injury of spinal cord or vertebral artery occurred.The postoperative and final follow-up ADI (2.6±1.3),(2.7±1.0) mm,CAA (143.1±6.4),(142.7±8.5) and SAC (18.7±3.4),(18.9±3.0) mm were compared with preoperative ADI[(9.0±3.2)mm],CAA[(120.5±13.1)]and SAC[(13.6±5.2) mm].And the differences were statistically significant (P<0.05).At the last follow-up,13 children with preoperative neurological symptoms attained ASIA grade E.And solid fusion and anatomical reduction were obtained on cervical CT scan without any loosening or fracturing of internal fixation.Conclusions For atlantoaxial instability and dislocation in children,posterior atlantoaxial screw-plate system fixation and autologous iliac cancellous bone graft fusion may achieve anatomical reduction and strong fixation and yield excellent outcomes of bone graft fusion.
References:
[1] Gallie WE.Fractures and dislocations of the cervical spine[J].Am J Surg,1939,46(3):495-499.DOI:10.1016/S0002-9610(39)90309-0.
[2] Brooks AL,Jenkins EB.Atlanto-axial arthrodesis by the wedge compression method[J].J Bone Joint Surg Am,1978,60(3):279-284.
[3] Jeanneret B,Magerl F.Primary posterior fusion C1/2 in odontoid fractures:indications,technique,and results of transarticular screw fixation[J].J Spinal Disord,1992,5(4):464-475.DOI:10.1097/00002517-199212000-00012.
[4] Brockmeyer DL,York JE,Apfelbaum RI.Anatomical suitability of C1-2 transarticular screw placement in pediatric patients[J].J Neurosurg,2000,92(1 Suppl):7-11.DOI:10.3171/spi.2000.92.1.0007.
[5] Anderson RCE,Ragel BT,Mocco J,et al.Selection of a rigid internal fixation construct for stabilization at the craniovertebral junction in pediatric patients[J].J Neurosurg,2007,107(1 Suppl):36-42.DOI:10.3171/PED-07/07/036.
[6] Gluf WM,Brockmeyer DL.Atlantoaxial transarticular screw fixation:a review of surgical indications,fusion rate,complications,and lessons learned in 67 pediatric patients[J].J Neurosurg Spine,2005,2(2):164-169.DOI:10.3171/spi.2005.2.2.0164.
[7] Goel A,Laheri V.Plate and screw fixation for atlanto-axial subluxation[J].Acta Neurochir (Wien),1994,129(1/2):47-53.DOI:10.1007/BF01400872.
[8] Goel A,Laheri V.Re:Harms J,Melcher P.Posterior C1-C2 fusion with polyaxial screw and rod fixation.(Spine 2001;26:2467-71)[J].Spine (Phila Pa 1976),2002,27(14):1589-1590.DOI:10.1097/00007632-200207150-00027.
[9] 党耕町,王超,阎明,等.后路寰枢椎侧块钉板固定植骨融合术的临床初探[J].中国脊柱脊髓杂志,2003,13(1):7-10.DOI:10.3969/j.issn.1004-406X.2003.01.003. Dang GD,Wang C,Yan M,et al.Primary report of lateral mass fixation between atlas and axis with screw-plate system[J].Chin J Spine Spinal Cord,2003,13(1):7-10.DOI:10.3969/j.issn.1004-406X.2003.01.003.
[10] 张美超,周海涛,王超,等.对寰枢椎侧块螺钉钛板固定装置的力学性能评价[J].中国脊柱脊髓杂志,2006,16(9):685-687,Ⅰ.DOI:10.3969/j.issn.1004-406X.2006.09.012. Zhang MC,Zhou HT,Wang C,et al.Finite element analysis of atlantoaxial screws and plates instrument for upper cervical spine stability[J].Chin J Spine Spinal Cord,2006,16(9):685-687,Ⅰ.DOI:10.3969/j.issn.1004-406X.2006.09.012.
[11] Wang SL,Wang C,Yan M,et al.Novel surgical classification and treatment strategy for atlantoaxial dislocations[J].Spine (Phila Pa 1976),2013,38(21):E1348-E1356.DOI:10.1097/BRS.0b013e3182a1e5e4.
[12] Wang C,Yan M,Zhou HT,et al.Open reduction of irreducible atlantoaxial dislocation by transoral anterior atlantoaxial release and posterior internal fixation[J].Spine (Phila Pa 1976),2006,31(11):E306-E313.DOI:10.1097/01.brs.0000217686.80327.e4.
Memo
收稿日期:2023-7-6。
基金项目:中央高水平医院临床科研业务费资助(2022-PUMCH-D-004)
通讯作者:郭东,Email:dr.guodong@vip.163.com