目的探索小儿严重寰枢椎不稳的手术治疗方式。方法回顾总结22例小儿严重寰枢椎不稳的临床资料，男16例，女6例，年龄3～14岁，平均11.4岁。病因有齿突骨折、横韧带断裂、枕颈畸形、类风湿关节炎等。所有患儿均行后路融合术，其中寰枢椎融合14例，枕颈融合术8例。结果 20例患儿经平均20个月(3个月～11年)随访，均获骨性融合，取得满意效果。结论上颈椎后路融合术是治疗小儿严重寰枢椎不稳的有效方法，对寰枢椎能复位者选择寰枢椎融合，脱位不能复位者应行枕颈融合术。%Objective To study surgical treatment of the children with serious atlantoaxial instability. Methods The surgical results of 22 children associated with serious atlantoaxial instability were reviewed. There were 16 boys and 6 girls, with their age ranging from 3 to 14 years (mean 11.4). Etiologies included dens fracture, disrupted transverse ligament, congenital anomalies of occipito-cervical,rheumatoid arthritis. All patients had posterior arthrodesis of the upper cervical spine. Atlantoaxial fusion was used to treat 14 patients. Occipito-cervical fusion was chosen for 8 patients. Results 20 patients were followed up for an average of 20 months (rang 3 months～11 years) and satisfactory results were demonstrated. All of them achieved solid osseous unions. Conclusions Fusion of the upper cervical spine was an effective procedures to treat children with atlantoaxial instability. Atlantoaxial fusion was chosen for the patient in who reduction of the atlantoaxial dislocation was feasible before surgery. The patient with irreducible atlantoaxial dislocation was treated by occipito-cervical fusion.
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