Park Seoung Woo, Cho Ki Hong, Shin Yong Sam, Kim Se Hyuk, Ahn Young Hwan, Cho Kyung Gi, Huh Ji Soon, Yoon Soo Han
Department of Neurosurgery, Kangwon National University College of Medicine, Chunchon, Korea.
Spine (Phila Pa 1976). 2005 Aug 1;30(15):E444-9. doi: 10.1097/01.brs.0000172226.35474.fe.
Clinical case report of atlantoaxial rotatory fixation (AARF) in a girl presenting with torticollis and neck pain.
To report this rare case that was successfully treated with long-term traction and a brace.
AARF is a rare kind of subluxation that is a pathologic fixation of the atlas on the axis. It is most common in pediatric patients and is usually reduced easily with conservative treatments only in the acute stage. However, previously reported chronic AARFs have usually been treated with operative reductions. Although high success rates have been achieved with operative reduction in chronic cases of AARF, even successful operative reduction may result in significant neck motion limitation.
A 9-year-old girl had torticollis of more than 3 months duration develop as a result of an upper respiratory infection. Dynamic computerized tomography showed consistent fixation of the atlantoaxial joint consistent with type 1 AARF according to the classification of Li and Pang. The patient was treated with halter traction of 5-lb weight for 6 weeks, and with a brace for 4 months and collar for 2 months.
We successfully treated this patient with chronic AARF only with cervical traction. She had full recovery of neck motion and normal atlantoaxial angle on follow-up computerized tomography after 6 months.
From this case, we suggest that long-term traction could be another treatment method for chronic AARF, especially in children.
一名出现斜颈和颈部疼痛的女孩的寰枢椎旋转固定（AARF）临床病例报告。
报告这例经长期牵引和支具成功治疗的罕见病例。
AARF是一种罕见的半脱位，即寰椎在枢椎上的病理性固定。它在儿科患者中最为常见，通常仅在急性期通过保守治疗即可轻松复位。然而，先前报道的慢性AARF通常采用手术复位治疗。尽管AARF慢性病例的手术复位取得了较高的成功率，但即使成功的手术复位也可能导致明显的颈部活动受限。
一名9岁女孩因上呼吸道感染出现持续3个多月的斜颈。动态计算机断层扫描显示寰枢关节固定，根据李和庞的分类符合1型AARF。患者接受5磅重量的颈托牵引6周，佩戴支具4个月，颈圈2个月。
我们仅通过颈椎牵引成功治疗了这名慢性AARF患者。6个月后随访计算机断层扫描显示，她的颈部活动完全恢复，寰枢角正常。
从这个病例来看，我们认为长期牵引可能是慢性AARF的另一种治疗方法，尤其是在儿童中。
