Liu Hu,Guo Dong,Li Chengxin,et al.Application of posterior atlantoaxial screw-rod fixation in the treatment of pediatric atlantoaxial instability and dislocation[J].Journal of Clinical Pediatric Surgery,2026,(05):462-466.[doi:10.3760/cma.j.cn101785-20260408-00161]
后路寰枢椎钉棒固定技术在儿童寰枢椎不稳定及脱位治疗中的应用研究
- Title:
- Application of posterior atlantoaxial screw-rod fixation in the treatment of pediatric atlantoaxial instability and dislocation
- Keywords:
- Atlantoaxial; Instability; Dislocation; Child; Screw-rod Fixation
- 摘要:
- 目的 评估后路寰枢椎钉棒固定技术治疗儿童寰枢椎不稳定及脱位的可行性、安全性与有效性。方法 回顾性分析首都医科大学附属北京儿童医院2012年1月至2022年1月接受手术的106例18岁以下患儿资料,男61例、女45例,平均年龄6.4岁。主要病因为先天性畸形、寰枢椎旋转固定性移位。106例均采用后路钉棒固定联合自体髂骨植骨术,2例行经口前路松解。结果 随访时间18~75个月,平均43.5个月。术中及术后均无一例发生神经、血管损伤及内固定相关并发症。术后及末次随访时,寰齿间距从术前(7.31±2.25)mm降至(2.94±1.98)mm,脊髓有效空间从术前(13.38±3.79)mm增至(19.45±3.82)mm,JOA评分从术前(14.83±1.91)分升至(16.85±0.82)分,差异均有统计学意义(t=13.614、-10.991、-12.362,P<0.001)。内固定位置良好,临床症状缓解,100例(94.3%)初次术后获骨性融合,余6例经再次植骨后亦融合。结论 后路寰枢椎钉棒固定技术治疗儿童寰枢椎不稳定及脱位安全有效,可有效复位固定、改善脊髓空间、促进融合并保护神经功能。
- Abstract:
- Objective Toevaluate the feasibility,safety,and efficacy of posterior atlantoaxial screw-rod fixation in the treatment of pediatric atlantoaxial instability and dislocation.Methods A retrospective analysis was conducted on 106 patients under 18 years of age who underwent surgery at Beijing Children’s Hospital,Capital Medical University,between January 2012 and January 2022.The cohort included 61 males and 45 females,with a mean age of 6.4 years.The main etiologies included congenital malformations and atlantoaxial rotatory fixation.All patients were treated with posterior screw-rod fixation combined with autologous iliac bone grafting,and two patients additionally underwent transoral anterior release.Results The follow-up period ranged from 18 to 75 months,with a mean of 43.5 months.No intraoperative or postoperative complications related to neurological or vascular injury,nor instrumentation-related complications,were observed.The atlantodental interval decreased from 7.31±2.25 mm preoperatively to 2.94±1.98 mm postoperatively and at final follow-up.The effective spinal cord space increased from 13.38±3.79 mm to 19.45±3.82 mm.The JOA score improved from 14.83±1.91 to 16.85±0.82.All differences were statistically significant (t=13.614,-10.991,-12.362; all P<0.001).Internal fixation was well positioned,and clinical symptoms were relieved.Primary bone fusion was achieved in 100 patients (94.3%),while the remaining six patients achieved fusion after secondary bone grafting.Conclusion Posterior atlantoaxial screw-rod fixation is a safe and effective technique for treating pediatric atlantoaxial instability and dislocation.It provides reliable reduction and stabilization,improves spinal cord space,promotes fusion,and preserves neurological function.
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备注/Memo
收稿日期:2026-4-8。
通讯作者:张学军,Email:zhang-x-j04@163.com