Huber Hanspeter, Ramseier Leonhard E, Boos Norbert
Spinal Surgery, University Hospital Balgrist, University of Zurich, Zurich, Switzerland.
J Pediatr Orthop. 2010 Mar;30(2):115-8. doi: 10.1097/BPO.0b013e3181cefe45.
The "odontoid synchondrosis fracture" represents a rare but typical injury of the upper cervical spine in children less than 7 years. Conservative treatment with closed reduction and external fixation shows fusion rates across the synchondrosis in about 90% cases. When closed reduction cannot be achieved, open reduction and internal fixation is usually performed. We present the case of a girl aged 3 years and 5 months, whose closed reduction by passive manipulation of the head failed, but the same could successfully be achieved through transoral manipulation of the dens. After treatment with a Minerva plaster cast, the fracture was healed without complication. We suggest transoral manipulation in cases of otherwise irreducible "odontoid synchondrosis fracture." This technical hint may avoid unnecessary surgery in children with this type of injury.
“齿突软骨结合部骨折”是7岁以下儿童上颈椎罕见但典型的损伤。闭合复位及外固定的保守治疗在约90%的病例中可使软骨结合部实现融合。若无法实现闭合复位，则通常进行切开复位内固定。我们报告一例3岁5个月女童的病例，其通过被动手法进行头部闭合复位失败，但通过经口手法处理齿突成功实现了闭合复位。用密涅瓦石膏固定治疗后，骨折愈合且无并发症。对于其他无法复位的“齿突软骨结合部骨折”病例，我们建议采用经口手法。这一技术提示可避免此类损伤儿童进行不必要的手术。
