CAJ | 학술논문

目的通过对17例寰枢关节旋转半脱位儿童临床表现，影像学资料的分析和研究，探讨儿童寰枢关节旋转半脱位的诊断方法和治疗效果。方法全部病例都在入院前后摄开口位X线片1次，治疗期间症状缓解后再摄同样条件下的X线片一次进行对比，必要时加做颈椎三维 CT并重建或MRI检查，正位X线片可以了解有无侧向移位及旋转移位，侧位片可以测量咽后壁软组织厚度（以第4颈椎水平为准）。如果颈疼和斜颈症状比较轻，而且持续存在不到1周，简单的用颈托领固定和口服止疼药物。持续1周以上，应该采取卧床休息、颌枕带等牵引和使用止疼药物。如果寰椎相对于枢椎向前移位，应该进行逐渐复位，并在矫正的位置上用头颅-躯干石膏或支具固定6周，病史已持续1-3个月，通常需要头颅环-躯干塑料背心牵引，持续3个月以上需要采取寰椎与枢椎融合手术。结果所有病例经治疗后痊愈出院，随访6个月---2年，平均13个月，X线片示齿状突居中，双侧寰齿间隙正常，CT提示寰前间隙正常，无1例复发，未留畸形，颈部旋转及屈伸正常。结论开口位X 线片是初期诊断寰枢关节半脱位理想的手段，对于诊断不清而又高度怀疑本病的，可以加做CT扫描和重建，治疗上以保守为主，难复性病例，可以采用后路植骨融合手术。
목적통과대17례환추관절선전반탈위인동림상표현，영상학자료적분석화연구，탐토인동환추관절선전반탈위적진단방법화치료효과。방법전부병례도재입원전후섭개구위X선편1차，치료기간증상완해후재섭동양조건하적X선편일차진행대비，필요시가주경추삼유 CT병중건혹MRI검사，정위X선편가이료해유무측향이위급선전이위，측위편가이측량인후벽연조직후도（이제4경추수평위준）。여과경동화사경증상비교경，이차지속존재불도1주，간단적용경탁령고정화구복지동약물。지속1주이상，응해채취와상휴식、합침대등견인화사용지동약물。여과환추상대우추추향전이위，응해진행축점복위，병재교정적위치상용두로-구간석고혹지구고정6주，병사이지속1-3개월，통상수요두로배-구간소료배심견인，지속3개월이상수요채취환추여추추융합수술。결과소유병례경치료후전유출원，수방6개월---2년，평균13개월，X선편시치상돌거중，쌍측환치간극정상，CT제시환전간극정상，무1례복발，미류기형，경부선전급굴신정상。결론개구위X 선편시초기진단환추관절반탈위이상적수단，대우진단불청이우고도부의본병적，가이가주CT소묘화중건，치료상이보수위주，난복성병례，가이채용후로식골융합수술。
Objective To study the diagnosis and treatment of children atlanto -axial subluxation( CAAS) .Method The clinical and pre-and posttreatment imagi-nologicalmaterials of 17 CAAS were reviewed and analyzed.There were 9 males and 8 femaleswith average age 8 years.Pre-and posttreatment mouth -open cervical an-terior-posterior and lateral X-ray films were taken for all cases,cervical 3D-CT and MRI were made if needed.Lateral and rotational disp lacement of CAAS could reveal in mouth-open cervical anterior-posterior radiographs,while thickness of post -pharyngeal soft tissue could show in latera X -ray films.Simple fixation with neck band and analgesic were used to treat caseswith mild neck pain and torticollis less than 1 week.Mandibulooccip ital belt traction and analgesic were taken for treat-ment of the cases with sign and symptom more than 1 week.For cases with anterior disp lacement,the disp lacement should be reduced then immobilized with head trunk cast or brace for 6 weeks.Cases with symp toms lasted for 1-3 months should be treated with halo -torse plastic vest traction.And atlanto-axial fusion should be app lied for caseswith symtoms lastingmore than 3 months.Result All cases were followed-up for 6 months to 2 yearswith average 1 year 1 months.Post-treatment radio-graphs showed odentoid process of axis centrally located and a normal bilateral atlas -dens intervals,aswell as CT scanning revealed normal axial anterior space .There were normal cervicalmotion without residual deformity and no recurrence of CAAS .Conclusion Mouth-open anterior-posterior radio-graph is an idealmeasure for ear-ly diagnosis of CAAS and CT scanning is choiceable for doubtful cases .Non -surgical treatment is main therapy for CAAS while posterior bone graft fusion of atlan-to2axial joint is selective method for non-reducible cases.