Muñiz A E, Belfer R A
Department of Emergency Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA.
Pediatr Emerg Care. 1999 Feb;15(1):25-9. doi: 10.1097/00006565-199902000-00008.
Traumatic torticollis is an uncommon complaint in the emergency department (ED). One important cause in children is atlantoaxial rotary subluxation. Most children present with pain, torticollis ("cock-robin" position), and diminished range of motion. The onset is spontaneous and usually occurs following minor trauma. A thorough history and physical examination will eliminate the various causes of torticollis. Radiographic evaluation will demonstrate persistent asymmetry of the odontoid in its relationship to the atlas. Computed tomography, especially a dynamic study, may be needed to verify the subluxation. Treatment varies with severity and duration of the abnormality. For minor and acute cases, a soft cervical collar, rest, and analgesics may be sufficient. For more severe cases, the child may be placed on head halter traction, and for long-standing cases, halo traction or even surgical interventions may be indicated. We describe two patients with atlantoaxial rotary subluxation, who presented with torticollis, to illustrate recognition and management in the ED.
创伤性斜颈在急诊科是一种不常见的病症。儿童患者的一个重要病因是寰枢椎旋转半脱位。大多数儿童表现为疼痛、斜颈（“知更鸟”姿势）以及活动范围减小。起病为自发性，通常发生在轻微创伤之后。详细的病史询问和体格检查将排除导致斜颈的各种病因。影像学评估会显示齿突与寰椎的关系持续不对称。可能需要计算机断层扫描，尤其是动态研究，以证实半脱位。治疗方法因异常情况的严重程度和持续时间而异。对于轻度和急性病例，使用软颈托、休息和止痛药物可能就足够了。对于更严重的病例，患儿可能需要进行头环牵引，而对于病程较长的病例，可能需要进行头环牵引甚至手术干预。我们描述了两名因寰枢椎旋转半脱位而出现斜颈的患者，以说明在急诊科对该病的识别和处理。
