Zhao Dongji Hui,Li Yun,Hu Binya,et al.Clinical characteristics and etiologies of atlantoaxial subluxation after adenoidectomy and/or tonsillectomy in children with obstructive sleep apnea-hypopnea syndrome[J].Journal of Clinical Pediatric Surgery,2026,(08):780-784.[doi:10.3760/cma.j.cn101785-20260521-00247]
儿童OSAHS腺样体和（或）扁桃体切除术后寰枢关节半脱位的临床特征与原因分析
- Title:
- Clinical characteristics and etiologies of atlantoaxial subluxation after adenoidectomy and/or tonsillectomy in children with obstructive sleep apnea-hypopnea syndrome
- 关键词:
- 阻塞性睡眠呼吸暂停低通气综合征; 腺样体切除术; 扁桃体切除术; 寰枢关节半脱位; 儿童
- Keywords:
- Obstructive Sleep Apnea Hypopnea Syndrome; Adenoidectomy; Tonsillectomy; Atlantoaxial Subluxation; Child
- 摘要:
- 目的 分析儿童阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome,OSAHS）行腺样体和（或）扁桃体切除术后并发寰枢关节半脱位的临床特征，探讨其发病原因及诊疗要点，为该病早期识别及干预提供参考依据。方法 本研究为回顾性病例系列研究，收集湖南省儿童医院耳鼻咽喉头颈外科2021年1月至2025年12月收治的13例腺样体和（或）扁桃体切除术后并发寰枢关节半脱位患儿临床资料，其中男8例、女5例，年龄（6.23±2.71）岁。分析患儿一般情况、术前多导睡眠监测（polysomnography,PSG）参数、手术相关数据、术后临床表现及影像学检查情况。结果 13例术前PSG均提示睡眠结构紊乱：深睡眠（N3期）比例为（10.2±3.1）%，显著低于正常值（15%~25%）；觉醒指数为（22.6±9.4）次/h，显著多于正常值（＜5次/h）。阻塞性呼吸暂停低通气指数（obstructive apnea-hypopnea index,OAHI）为（18.7±12.3）次/h，其中轻度5例（OAHI 1~5次/h）、中度4例（>5~10次/h）、重度4例（>10次/h）；最低SpO2为（82.4±7.6）%，约84.6%的患儿＜85%，SpO2＜90%时长占比为（15.8±11.2）%，均超过临床干预阈值（＞5%）。术中颈部后伸角度为15°~35°，平均（24.6±5.1）°。患儿于术后（5.15±2.03）d出现“颈痛、颈活动受限、斜颈畸形”三联征，术后出现发热11例。11例行扁桃体＋腺样体切除术，2例行腺样体切除术：手术时间（29.31±5.51）min，出血量（4.69±1.70）mL。影像学检查均符合寰枢关节半脱位。10例予静脉抗感染联合牵引及物理治疗，3例仅行物理治疗，恢复时间（12.85±2.38）d，无一例遗留神经系统后遗症。结论 寰枢关节半脱位是儿童OSAHS腺样体和（或）扁桃体切除术后一种罕见而严重的并发症，患儿主要表现为术后急性颈痛、斜颈及颈部活动受限，结合颈椎CT可确诊。其发生与以下因素相关：术后局部炎症刺激扩散致韧带松弛，OSAHS长期慢性缺氧、异常呼吸力学负荷致韧带稳定性下降，术中颈椎过度后伸。早期抗感染、颈椎牵引等综合治疗预后良好，无神经系统后遗症。在临床实践中，通过术中严格控制颈椎体位、术后对中重度OSAHS及低龄患儿加强颈部症状监测，有望降低该并发症的发生率。
- Abstract:
- Objective To explore the clinical features of atlantoaxial subluxation (Grisel syndrome) after adenoidectomy and/or tonsillectomy in children with obstructive sleep apnea-hypopnea syndrome (OSAHS),elucidate its pathogenesis and summarize key diagnostic and therapeutic strategies to provide rationales for early clinical identification,intervention and prevention. Methods A retrospective analysis was conducted for the clinical data of 13 children diagnosed with atlantoaxial subluxation after adenoidectomy and/or tonsillectomy at Department of Otolaryngology,Head and Neck Surgery,Hunan Children’s Hospital. between January 2021 and December 2025.There were 8 boys and 5 girls with a mean age of (6.23±2.71) year.Collected data included general profiles,preoperative polysomnography (PSG) parameters,surgical parameters,postoperative clinical manifestations and imaging findings.The diagnostic approaches and treatment outcomes were summarized. Results Preoperative polysomnography (PSG) revealed sleep architecture disturbances (n=13).The proportion of deep sleep (N3 stage) (10.2±3.1)% was significantly lower than normal range (15%-25%).Arousal index was (22.6±9.4) events/h and it was markedly higher than normal value (<5 events/hour).Average obstructive apnea-hypopnea index (OAHI) was (18.7±12.3) events/hour，including mild (n=5,OAHI 1-5 events/hour),moderate (n=4,>5-10 events/hour) and severe (n=4,>10 events/hour).The lowest oxygen saturation (SpO2) was (82.4±7.6)% with 84.6% of them showing SpO2<85%; percentage of time spent with SpO2 <90% was (15.8±11.2)%,exceeding clinical intervention threshold (>5%).Intraoperative cervical extension ranged from 15° to 35°,averaging (24.6±5.1)°.All of them presented with a classic triad of neck pain,limited neck motion and torticollis at a mean of (5.15±2.03) days postoperatively.Eleven cases (84.6%) developed postoperative fever.Combined tonsillectomy and adenoidectomy (n=11) and adenoidectomy alone (n=2) were performed with a mean operative duration of (29.31±5.51) min and a mean intraoperative volume of blood loss (4.69±1.70) ml.Imaging findings were consistent with atlantoaxial subluxation.Intravenous antibiotics plus traction and physical therapy (n=10) and physical therapy alone (n=3) were offered.During a mean recovery time of (12.85±2.38) day,no neurological sequelae occurred. Conclusion Atlantoaxial subluxation is a rare and serious complication after adenoidectomy and/or tonsillectomy in OSAHS children.The predominant clinical manifestations are acute postoperative neck pain,torticollis and limited neck motion.A definite diagnosis may be made by cervical computed tomography (CT).Its occurrence is associated with multiple factors,including ligament laxity induced by spread of local postoperative inflammatory stimulation,reduced ligament stability caused by long-term chronic hypoxia and abnormal respiratory mechanical load secondary to OSAHS,as well as intraoperative cervical hyperextension.Early comprehensive treatment of antibiotics and cervical traction achieves a favorable prognosis without neurological sequelae.In clinical practices,strict intraoperative control of cervical position and enhanced postoperative monitoring of neck symptoms in young children and those with moderate-to-severe OSAHS may effectively lower the incidence of complications.
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备注/Memo
收稿日期:2026-5-21。
基金项目:湖南省自然科学基金(2025JJ80649)
通讯作者:胡彬雅,Email:zhizi628@126.com