Parada Stephen A, Arrington Edward D, Kowalski Kurtis L, Molinari Robert W
Madigan Army Medical Center, 9040A Fitzsimmons Dr, Joint Base Lewis McChord, WA 98431, USA.
Orthopedics. 2010 Dec 1;33(12):929. doi: 10.3928/01477447-20101021-31.
Facet dislocations in children are rare. This article presents the youngest case of a unilateral facet dislocation described in the pediatric population. A 9-year-old boy sustained a flexion/axial loading injury to his cervical spine while wrestling with his friends, causing a unilateral facet dislocation at C4/5. Prereduction magnetic resonance imaging (MRI) demonstrated the absence of a diskal herniation or cord impingement and an intact posterior ligamentous complex. Due to the patient's young age, the decision was made to forgo a supervised awake closed reduction. Closed reduction was performed under general anesthesia with somatosensory-evoked potential and motor-evoked potential monitoring. Closed reduction was successfully achieved after Gardner-Wells tongs were applied and used to manually direct slow, steady in-line traction, along with slight flexion and posterior rotation of the dislocated side under direct fluoroscopy. The patient was immediately awakened from anesthesia and was found to have an intact sensory examination. He was immobilized in a cervical collar for 12 weeks. At 2-year follow-up, he remained asymptomatic without recurrence and had painless full range of motion of the cervical spine. Radiographs revealed a normally aligned cervical spine. Unilateral cervical facet dislocations and subluxations are the result of a distractionflexion force applied to the spine along with a rotational component. These are not uncommon injuries in the adult spine; however, in the young pediatric population, cervical facet dislocations are rare.
小儿关节突关节脱位较为罕见。本文介绍了小儿人群中描述的最年轻的单侧关节突关节脱位病例。一名9岁男孩在与朋友摔跤时颈椎遭受屈曲/轴向负荷损伤，导致C4/5单侧关节突关节脱位。复位前磁共振成像（MRI）显示无椎间盘突出或脊髓受压，后韧带复合体完整。由于患者年龄较小，决定放弃在监护下清醒闭合复位。在全身麻醉下进行闭合复位，并进行体感诱发电位和运动诱发电位监测。应用Gardner-Wells钳并在直接透视下手动缓慢、稳定地进行轴向牵引，同时对脱位侧进行轻微屈曲和后旋，成功实现了闭合复位。患者立即从麻醉中苏醒，感觉检查正常。他佩戴颈托固定12周。在2年的随访中，他无症状且无复发，颈椎活动范围正常且无痛。X线片显示颈椎排列正常。单侧颈椎关节突关节脱位和半脱位是脊柱受到牵张屈曲力并伴有旋转成分的结果。这些损伤在成人脊柱中并不少见；然而，在小儿人群中，颈椎关节突关节脱位很少见。
