Treatment strategy of rotatory dislocation of atlantoaxial articulation in children / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To analyze appropriate strategy about treatment of rotatory dislocation of atlantoaxial articulation in children.</p><p><b>METHODS</b>From March 2005 to February 2009, 36 patients with rotatory dislocation of atlantoaxial articulation were retrospectively analyzed, including 25 males and 11 females, with the average age of 7.8 years (ranged 3 - 14 years). According to Fielding-Hawkins clinical classification, type I 24 cases, type II 8 cases, type III 2 cases, type IV 2 cases. All of the patients were assessed rotatory dislocation of atlantoaxial articulation and whether or not upper cervical spine malformation by X-ray, MRI and CT scan and three-dimensional reconstruction. Thirty-two cases received observational treatments which were reduction after cervical traction, without appearance of the deformity, without neurological symptoms. And another 4 serious cases (irreducible atlantoaxial dislocation or with os odontoideum) received posterior atlantoaxial fixed autograft fusion.</p><p><b>RESULTS</b>Rotation of atlas decreased from 16.0° ± 4.4° (range, 5° to 26°) pre-therapy to 4.5° ± 1.5° (range, 0° to 8°) post-therapy in 35 cases, rotation of atlas had significant difference between pre-therapy and post-therapy (t = 14.75, P < 0.05). One patient pre-therapy rotation of atlas was 45°, post-therapy was 4°. All patients were followed up for 14 - 38 months (mean, 18 months), 32 cases who received cervical traction and external fixation resulted in satisfactory outcome in which all the ankylodeire were disappear, bilateral masses were symmetrical on anterior-posterior and good functional activities of cervical. All the 4 cases surgically treated obtained reduction, sound bony fusion and neural symptoms were improved obviously after operation.</p><p><b>CONCLUSIONS</b>Conservative treatment has been proved to be very effective in most of rotatory dislocation of atlantoaxial articulation in children. However, operative treatment should be considered in the following situations irreducible atlantoaxial dislocation or patients with os odontoideum.</p>