Abstract: Objective To explore the characteristics and advantages of spinal (fixed-point) rotational repositioning method in treating atlantoaxial thrust semi-subluxation in children. Methods Thirty-five cases of atlantoaxial push semimedullary dislocation in children were treated with spinal (fixed-point) rotational repositioning method together with anti-inflammatory and traditional Chinese medicine hot compresses. Results All children were clinically cured. Conclusion Spinal (fixed-point) rotational repositioning method is effective in treating atlantoaxial subluxation in children. Methods cylinder single. Liu Yishan, Department of Traditional Chinese and Western Medicine, Air Force General Hospital Keywords: spine; manipulation. Orthopaedics; dislocation; atlantoaxial joint/injury CCTS: R274; R687-33; R726.847 Literature identification code: A Treatment effect of FSM (Feng’S spinal manipulation) on patient with atlantoaxial subluxation of children LIU Yi-shan, GUO Wei, LIANG Li (Center of Integrated Traditional and Western Medicine of Manipulative Orthopedic Center of Integrated Traditional and Western Medicine of Manipulative Orthopedic, General Hospital of Air Force, Beijing 100036, China) Abstract: Objective To evaluate the treatment effect of FSM on patient with atlantoaxial subluxation of children. Methods 3 5 cases were treated with FSM, anti-inflammatory and chliasm. Results All patients recovered fully and the mechanism was discussed. Conclusion FSM is a very effective treatment in treating the patient with atlantoaxial subluxation. Key words: Spine; Manipulation, orthopedic; Dislocations; Atlant0-Axial Joint/injuries Atlantoaxial subluxation is characterized by neck pain, cervical strabismus, and extreme limitation of cervical motion [1]. The treatment experience of 35 cases of atlantoaxial subluxation admitted to our department from January 2001 to January 2006 is summarized as follows: 1 Data and Methods 1.1 General Data There were 35 cases of children in this group, of which 19 cases were male and 16 cases were female, with a male to female ratio of 1:0.84. The age of the children ranged from 1 to 14 years old, of which 7 cases were between the ages of 1 and 5 years old and 23 cases were between the ages of 6 and 10 years old. 5 cases were above the age of 10 years old, with an average age of 7.96 ± 4 years. The average age was 7.96±4 years. The duration of the disease was 3 h-5 months, with an average of 7.74±4 d. There were 21 cases of minor neck trauma, accounting for 602%; 10 cases of upper respiratory tract infection, accounting for 29%; and 4 cases of unknown records, accounting for 11%. All the children had different degrees of head movement limitation. All the children had different degrees of head movement limitation, or head and neck tilt fixed in a certain position can not be automatically corrected. Some children were accompanied by dizziness, nausea and tinnitus. 1.2 X-ray diagnostic criteria: the distance between the back of the anterior arch of the atlas and the front of the odontoid process is widened, which is more than 3mm, and the line connecting the anterior edge of the cervical vertebrae, the line connecting the posterior edge of the vertebrae, and the line connecting the lateral joints (referred to as the three C-curve) is abnormal [2]. The open orthopantomogram showed that the gap between the odontoid process and the atlantoaxial lateral block was asymmetric. 1.3 Treatment plan 1.3.1 Anti-infective treatment Most of the children had inflammation in the pharynx, antibiotic treatment was given first, penicillin drugs were preferred, the dosage was according to the weight of the children, usually 5-7d, and those who were allergic to penicillin were changed to other broad-spectrum antibiotics. Only after the inflammation subsides can the treatment of spinal (fixed-point) rotational repositioning method be implemented [3]. 1.3.2 Dehydration therapy for obvious neck edema is first given to dehydration therapy, program: glycerol fructose injection 250 ml, once a day, generally 3-5d. 1.3.3 Chinese medicine hot compresses Hot compresses of topical traditional Chinese medicine can promote the local soft tissues to reduce swelling, relieve pain, and relieve muscle spasm. Hot compresses should be applied to the neck twice a day. 1.3.4 Cervical small joint capsule closure Rapidly eliminate the cervical small joint capsule aseptic swelling, reduce the stimulation of aseptic inflammation, increase the stability of the vertebral body after repositioning, is an important adjuvant therapy. Treatment plan: 2% lidocaine l ml plus dexamethasone 2 mg or 2% lidocaine 1 ml plus Depo-Prostone injection 1 ml, do local closure of the swollen cervical small joint capsule, usually l~2 times. 1.3.5 Cervical ultrashort wave physiotherapy once a day, each time l5 min, 10 times for a course of treatment. 1.3.6 Spinal (fixed-point) rotational repositioning method Correcting the skewed vertebrae is the key to treatment, spinal (fixed-point) rotational repositioning method is “stable, accurate, light and skillful”, which is easy for children to accept, and the treatment is simple, and generally children only need 1 to 2 times of manipulation: 1.3.7 Cervical circumference immobilization The neck circumference should be of suitable size, elasticity, and softness. suitable. 1.3.8 Pillow selection Children’s pillows should be appropriate elasticity, the pillow should not be too hard. Cotton or buckwheat skin is good, the height of the compressed equivalent to the height of their fists is appropriate, the shape of the pillow to the center of the depression on both sides of the high up is appropriate. Contact with the cervical spine part should be cylindrical, in order to set off and support the neck curve, the head is placed in the depression, to maintain a low head, high neck, back flat position. 1.3.9 Rice word exercise function exercise patient upright, feet naturally separated from shoulder width, with the tip of the nose as the “tip of the pen”, the neck left and right rotation, lateral flexion, forward flexion, backward tilt, to write the word rice as a movement, after each write a word rice, with the head around the “rice” word rotation circle, the head should be placed in the depression. Every time you finish writing a character of rice, rotate your head around the character “Mi”, repeat l0-15 times. 1.4 Clinical cure criteria: pain in the neck and occipital region disappeared, head and neck deviation was corrected, neck flexion and extension and rotation function returned to normal, X-ray showed that the distance between the anterior edge of the dentate process of the cardinal vertebrae and the posterior edge of the atlantoaxial arch was ≤3 mm, the physiological anterior protruding arc of the cervical vertebral body returned to normal, and the distance between atlantoaxial spinous processes returned to normal [4]. 2 Results All 35 children in this group were clinically cured, with the number of manipulations from 1 to 8 times, the average of 2.8±4 times, the number of hospitalization days from 4 to 28d, the average of hospitalization 12±4d, and the cure rate of l00%. 3 Discussion Atlantoaxial subluxation in children is different from that in adults, the pediatric cervical activity pivot point is closer to the atlantoaxial vertebrae than the adult activity pivot point, coupled with the relatively large skull and relatively weak neck muscle strength in children, the articular eminence is more horizontal, and the development of intervertebral joints is incomplete, and these structures cause cervical spine injuries in children mostly related to the anatomical characteristics of the upper cervical segments [5]. From the cases in this group, the highest incidence rate was found in children aged 6-10 years old, which was related to the imperfect development of atlanto- transverse ligament and cruciate ligament, and the lack of self-protection ability of the children in this age group; the inflammatory congestion and edema of the soft tissues of the pharyngeal region in children with pharyngeal infections seriously affects the stability of atlanto-atlantoaxial joints, which makes the development of the disease easier; the prolonged bad postures tend to cause atlanto-atlantoaxial joint capsule swelling, which influences the stability of atlantoaxial joints, leading to the development of atlanto-axial joints. The prolonged poor posture may cause swelling of the atlantoaxial small joint capsule, which may affect the stability of the atlantoaxial joint and lead to atlantoaxial subluxation. Treatment principle: eliminate the factors affecting the stability of the atlantoaxial joint as soon as possible, and then use the spinal column (fixed-point) rotational reset method to treat the problem, which often can be completely reset in one or two times. Spinal (fixed-point) rotational repositioning method has the characteristics of “stable, accurate, light, clever”, because of its light force. The child is easy to accept, and small damage, fast recovery, should be widely promoted: In addition, the timing of manipulation is also very important. The timing of the maneuver is also very important. References ［1］ Shao Xuan, Xu Jingbin. Practical Neck and Back Pain [M]. Beijing: People’s Army Medical Press, 1992. 253. ［2］ Li Lei. Atlantoaxial subluxation in children 5 cases of diagnosis and treatment experience [J]. Chinese orthopedics, l996,8(6):44. ［3］ Feng Tianyu, ed. Clinical research on the treatment of soft tissue injury by combining traditional Chinese and western medicine [M]. Beijing: China Science and Technology Press. 200l. 75-76. ［4］ Liao Shuncai, Zeng Fei, Zhai Xinmin, et al. Liao Shuncai, Zeng Fei, Zhai Xinmin. Liao Shuncai, Zeng Fei, Zhai Xin. 86 cases of pediatric atlantoaxial subluxation treated with maxillofacial bandage traction［J］. ［J］, Liao Shuncai, Zeng Fei, Zhai Xinmin, et al. 86 cases of pediatric atlantoaxial subluxation treated with maxillary bandage traction [J].