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Rehabilitation Practice and Science

Translated Title

唐氏症合併先天性分離狀齒樣突及脊髓損傷：病例報告

Abstract

Down syndrome is a genetic disorder caused by trisomy on chromosome 21 that occurs in 1 of every 800 live births. Down syndrome can involve skeletal malformations that include patella or hip dislocation, genu valgus and atlanto-axial instability (AAI). Prompt recognition and treatment of the latter is important. This casereport describes an odontoid fracture due to AAI in a seven-year-old with Down syndrome.
Since October 2000, the child had involved in robust activities including floor tumbling and hand stands. Beginning in April 2001, the right extremities showed signs of weakness and there was an unsteady gait. Upon physical examination, AAI with combined cord compression was suspected. X-ray and MRI showed an os odontoideum combined odontoid fracture with cord compression. In May, the first surgery was carried out and a wire was used to fix the occiput to Cl and C2. Post surgery outcome did not meet expectations. A second surgery was conducted in June, whereupon Cl laminectomy provided internal fixation from the occiput to C6. Upon admittance to the rehabilitation ward, his muscle power was grade four and three over the left and right side, respectively. He could not walk or stand and sphincter incontinence was also noted. Therapy included strengthening, ambulation and bladder/bowel training. After rehabilitative therapy for a month, muscle power had improved to grade five for the left side and grade four for the right side. The patient could walk short distances and climb stairs independently and exhibited improved bladder/bowel control. The only thing that did not improve was the patient's stiff neck, which was caused by the internal fixation. This could not be helped by the therapy and disturbed his daily life.

Language

Traditional Chinese

First Page

47

Last Page

53

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