Departments of Orthopaedic Surgery, School of Medicine, Keio University, Shinjuku, Tokyo, Japan.
Spine (Phila Pa 1976). 2011 Feb 15;36(4):E256-62. doi: 10.1097/BRS.0b013e3181d8bbdd.
A retrospective case series.
To propose a novel treatment strategy for chronic atlantoaxial rotatory fixation (AARF).
Treatment strategy for chronic or recurrent AARF remains controversial. We have previously reported that a deformity of the superior facet of the axis (C2 facet deformity), which is frequently observed in patients with chronic AARFs, is a risk factor for recurrent dislocation. In this article, we report seven consecutive cases of chronic AARF who underwent closed manipulation followed by external halo fixation and maintained good reduction with the remodeling of the C2 facet deformity.
Seven girls with a chronic AARF who sustained torticollis for an average of 4.6 months after the onset were referred to our clinic. Closed manipulation by careful manipulation under general anesthesia followed by external immobilization with a halo vest was performed in all cases. Radiographic findings and clinical courses were retrospectively reviewed with approvals by the institutional review board.
Three-dimensional computed tomography images before reduction revealed persistent atlantoaxial subluxation and the C2 facet deformity in the dislocated side in all cases. Follow-up three-dimensional computed tomographic scans demonstrated the remodeling of the C2 facet deformity at an average of 2.8 months after successful reduction of subluxation. Subsequently, the halo vests were removed and gentle neck range of motion exercise was started in all cases. The normal cervical range of motion was obtained 2 weeks after the removal of halo vests in five cases, whereas the range of motion remained limited in two cases. At a mean follow-up of 17.4 months, neither symptoms nor recurrence of subluxation occurred in all cases.
Chronic irreducible and recurrent unstable AARF can be managed successfully by careful closed manipulation followed by halo fixation, if the C1 and C2 have not been osseously fused. The remodeling of the C2 facet deformity detected on follow-up CT scans can be a useful radiographic parameter to determine the appropriate period of halo fixation in this new treatment strategy obviating the need for surgical intervention.
回顾性病例系列。
提出慢性寰枢椎旋转固定（AARF）的新治疗策略。
慢性或复发性 AARF 的治疗策略仍存在争议。我们之前曾报道过，在慢性 AARF 患者中经常观察到的枢椎上关节面畸形（C2 关节面畸形）是复发性脱位的危险因素。在本文中，我们报告了 7 例连续的慢性 AARF 病例，这些病例在发病后平均 4.6 个月出现斜颈，通过仔细的全麻下闭合手法复位，然后用 halo 背心外固定，随着 C2 关节面畸形的重塑，维持了良好的复位。
7 例慢性 AARF 女孩在发病后平均 4.6 个月出现斜颈，均在全麻下进行闭合手法复位，然后用 halo 背心外固定。在获得机构审查委员会批准后，对所有病例进行回顾性影像学表现和临床病程分析。
所有病例在复位前的三维 CT 图像均显示持续性寰枢关节半脱位和脱位侧的 C2 关节面畸形。在成功复位半脱位后的平均 2.8 个月，随访三维 CT 扫描显示 C2 关节面畸形的重塑。随后，所有病例均移除 halo 背心并开始轻柔的颈部活动范围锻炼。在 5 例病例中， halo 背心移除后 2 周即可获得正常的颈椎活动范围，而在 2 例病例中活动范围仍然有限。在平均 17.4 个月的随访中，所有病例均未出现症状或半脱位复发。
如果 C1 和 C2 没有骨融合，通过仔细的闭合手法复位，然后 halo 固定，可以成功治疗慢性不可复位和复发性不稳定的 AARF。在这种新的治疗策略中，随访 CT 扫描中发现的 C2 关节面畸形的重塑可以作为一个有用的影像学参数，以确定 halo 固定的适当时间，避免手术干预的需要。
