臨床整形外科45巻10号

2010年10月発行

臨床経験

小児環軸関節回旋不安定症の治療困難例に対する手術療法

著者： 村田泰章¹ 久保田元也¹ 金谷幸一¹ 和田啓義¹ 和田圭司¹ 柴正弘¹ 八田哲¹ 加藤義治¹

所属機関： ¹東京女子医科大学整形外科

ページ範囲：P.961 - P.965

目的：小児環軸関節回旋不安定症の治療困難例を手術的に治療したので，その経過を報告する．

対象と方法：保存的治療で改善が得られなかった小児7例に対し，環軸椎後方固定術を施行した．

結果：3例にBrooks法を，4例にMagerl ＆ Brooks法を施行し，全例で骨癒合が得られ，症状は消失した．術後経過平均7年時，頚椎の可動域は全例正常であった．

結語：Brooks法は3歳以上，Magerl ＆ Brooks法は7歳以上の症例で施行でき，経過観察中，再発や可動域制限などの問題は生じていない．

参考文献

1) Brockmeyer DL, Apfelbaum RI:A new occipitocervical fusion construct in pediatric patients with occipitocervical instability. Technical note. J Neurosurg 90:271-275, 1999

2) Burgos-Vargas R, Clark P:Axial involvement in the seronegative enthesopathy and arthropathy syndrome and its progression to ankylosing spondylitis. J Rheumatol 16:192-197, 1989

3) Burgos-Vargas R, Naranjo A, Castillo J, et al:Ankylosing spondylitis in the Mexican mestizo:patterns of desease according to age at onset. J Rheumatol 16:186-191, 1989

4) Crossman JE, David K, Hayward R, et al:Open reduction of pediatric atlantoaxial rotatory fixation:Long-term outcome study with functional measurements. J Neurosurg 100(suppl):235-240, 2004

5) Crossman JE, Thompson D, Hayward RD, et al:Recurrent atlantoaxial rotatory fixation in children:A rare complication of a rare condition. Report of four cases. J Neurosurg 100(suppl):307-311, 2004

6) Crostelli M, Mariani M, Mazza O, et al:Cervical fixation in the pediatric patient:our experience. Eur Spine J Suppl 1:20-28, 2009

7) Eadie PA, Moran R, Fogarty EE, et al:Rotatory atlanto-axial subluxation following pharyngoplasty. Br J Plast Surg 42:722-723, 1989

8) El-Khoury GY, Clark CR, Gravett AW:Acute traumatic atlanto-axial rotatory dislocation in children. J Bone Joint Surg Am 66:774-777, 1994

9) Fernandez Cornejo VJ, Martinez-Lage JF, Piqueras C, et al:Inflammatory atlanto-axial subluxation (Grisel's syndrome) in children:Clinical diagnosis and management. Childs Nerv Syst 19:342-347, 2003

10) Fielding JW, Hawkins RJ:Atlanto-axial rotatory fixation (fixed rotatory subluxation of the atlanto-axial joint). J Bone Joint Surg Am 59:37-44, 1977

11) Fielding JW, Hawkins RJ, Hensinger RN, et al:Atlanto-axial rotatory deformities. Orthop Clin North Am 9:955-967, 1978

12) Foster HE, Cairns RA, Burnell RH, et al:Atlantoaxial subluxation in children with seronegative enthesopathy and arthropathy syndrome:2 case reports and a review of the literature. J Rheumatol 22:548-551, 1995

13) Fox MW, Onofrio BM, Kilgore JE:Neurological complications of ankylosing spondylitis. J Neurosurg 78:871-878, 1993

14) Goto S, Mochizuki M, Kita T, et al:Transoral joint release of the dislocated atlantoaxial joints combined with posterior reduction and fusion for a late infantile atlantoaxial rotatory fixation:A case report. Spine 23:1485-1489, 1998

15) Govender S, Kumar KP:Staged reduction and stabilisation in chronic atlantoaxial rotatory fixation. J Bone Joint Surg Br 84:727-731, 2002

16) Hamilton MG, MacRae ME:Atlantoaxial dislocation as the presenting symptom of ankylosing spondylitis. Spine 18:2344-2346, 1993

17) Hettiaratchy S, Ning C, Sabin I:Nontraumatic atlanto-occipital and atlantoaxial rotatory subluxation:Case report. Neurosurgery 43:162-164, 1998

18) Martinez-Lage JF, Martinez Perez M, Fernandez Cornejo V, et al:Atlanto-axial rotatory subluxation in children:Early management. Acta Neurochir (Wien) 143:1223-1228, 2001

19) Parisini P, Di Silvestre M, Greggi T, et al:C1-C2 posterior fusion in growing patients:Long-term follow-up. Spine 28:566-572, 2003

20) Phillips WA, Hensinger RN:The management of rotatory atlanto-axial subluxation in children. J Bone Joint Surg Am 71:664-668, 1989

21) Sherk HH, Nicholson JT:Rotatory atlanto-axial dislocation associated with ossiculum terminale and mongolism. J Bone Joint Surg Am 51:957-964, 1969

22) Subach BR, McLaughlin MR, Albright AL, et al:Current management of pediatric atlantoaxial rotatory subluxation. 23:2174-2179, 1998

23) Wang J, Vokshoor A, Kim S, et al:Pediatric atlantoaxial instability:Management with screw fixation. Pediatr Neurosurg 30:70-78, 1999