Therapeutic effect of posterior cervical internal fixation against Down's syndrome and atlantoaxial instability in children
LIU Hu, LI Chengxin
Department of Orthopedics, Affiliated Beijing Children's Hospital, Capital Medical University & National Children's Medical Center, Beijing 100045, China
Abstract：Objective To study the effect of posterior internal fixation in children with Down's syndrome(DS) and atlantoaxial instability(AAI).Methods The clinical data on twelve children with Down's syndrome and atlantoaxial instability treated at our hospital between June 2012 and November 2018 was retrospectively analyzed. These patients consisted of 5 males and 7 females, aged 3 to 14, and with an average age of (6.9±3.1) years. All these patients received cervical X-rays and CT scan with reconstruction to find out about the development of the vertebral body, C1 lateral mass, C2 pedicle and vertebral artery (VA). In children with spinal cord compression, MRI examination of the cervical spine was upgraded. The patients were followed up regularly. The X-ray films of the cervical spine and CT scan with 3D reconstruction were performed to detect the levels of atlantoaxial alignment, bone graft fusion and internal fixation. The ADI and SAC values were measured and recorded preoperatively, postoperatively and during the last follow-up.Results The mean follow-up time was (2.6±1.2) years (range 1.6-4.9 years). C1 lateral mass screws and C2 pedicle screws were performed in ten of the twelve children, and the other two cases were treated with occipital plates and C1,2 screws for occipitocervical fixation and fusion. ADI decreased from (7.0±2.1)mm before surgery to (1.4±0.8)mm during the last follow-up (P<0.01), and SAC increased from (13.6±5.2)mm to (19.0±3.0)mm (P<0.01). All the patients underwent regular neck CT examinations in the 3rd and 6th months after operation. By the last follow-up, all the children enjoyed good bone fusion.Conclusions For children with DS and AAI, posterior C1, C2 screw fixation and occipital plate internal fixation can achieve good therapeutic effect.
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