Smith Kevin M, Yoganandan Narayan, Pintar Frank A, Kurpad Shekar N, Maiman Dennis J
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
J Craniovertebr Junction Spine. 2010 Jul;1(2):113-7. doi: 10.4103/0974-8237.77675.
Numerous reports of atlantooccipital dislocations (AODs) have been described in frontal impacts and vehicle versus pedestrian collisions. Reports of survival after AOD in conjunction with side impacts have infrequently been reported in the literature. The objective of this study is to present a case of an AOD from a side impact vehicle collision, and deduce the mechanism of injury. A clinical and biomechanical reconstruction of the collision was performed to investigate the mechanism of the dislocation. A 51-year-old female was traveling in a four-door sedan and sustained a side impact collision with a compact pickup truck. At the time of extrication, the patient was neurologically intact with a Glasgow Coma Scale score of 15. After admittance to the hospital, the patient developed a decline in respiratory status, right mild hemiparesis, and left sixth-nerve palsy, and magnetic resonance imaging (MRI) and computed tomography (CT) reconstructions indicated a craniocervical dislocation. Surgical fixation was performed and all extra-axial hemorrhaging was evacuated. At discharge, the patient was neurologically intact on the left side, had right mild hemiparesis, left sixth-nerve palsy, and minor dysarthria. Survival rates of AODs have recently been increasing. Morbidity is still more prevalent, however. Due to the variety of symptoms that accompany AODs and the inconsistency of diagnostic imaging techniques, a thorough history of the etiology may lead to increased clinical suspicion of this injury and further raise survival rates.
已有众多关于寰枕关节脱位（AOD）在正面碰撞以及车辆与行人碰撞中的报道。然而，关于AOD合并侧面碰撞后存活的报道在文献中却鲜有出现。本研究的目的是呈现一例因侧面车辆碰撞导致的AOD病例，并推断损伤机制。对该碰撞进行了临床和生物力学重建以探究脱位机制。一名51岁女性乘坐四门轿车时与一辆紧凑型皮卡发生侧面碰撞。在解救时，患者神经功能完好，格拉斯哥昏迷量表评分为15分。入院后，患者出现呼吸状况下降、右侧轻度偏瘫和左侧第六神经麻痹，磁共振成像（MRI）和计算机断层扫描（CT）重建显示颅颈脱位。进行了手术固定并清除了所有轴外出血。出院时，患者左侧神经功能完好，有右侧轻度偏瘫、左侧第六神经麻痹和轻度构音障碍。近期AOD的存活率一直在上升。然而，发病率仍然更为普遍。由于AOD伴随的症状多样且诊断成像技术不一致，详尽的病因病史可能会提高临床对此损伤的怀疑，并进一步提高存活率。
