Tauchi Ryoji, Imagama Shiro, Ito Zenya, Ando Kei, Muramoto Akio, Matsui Hiroki, Matsumoto Tomohiro, Yukawa Yasutsugu, Kanemura Tokumi, Ishiguro Naoki
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Pediatr Orthop B. 2013 Sep;22(5):404-8. doi: 10.1097/BPB.0b013e3283633064.
Six consecutive pediatric patients with chronic atlantoaxial rotatory fixation (AARF) underwent posterior fixation. All patients were first treated conservatively such as with a neck collar, traction, Minerva jacket, or halo-vest; however, they failed to achieve successful reduction because of the C2 facet deformity or C1-2 facet fusion. We performed C1-2 fusion using a C1 lateral mass screw and a C2 pedicle screw, a C1-2 transarticular screw, or an occipitocervical fusion using a rod and wiring system. Five patients achieved solid fusion with no torticollis or neck pain by the final follow-up. One patient had mild torticollis after surgery but no pain. Although we believe that with early diagnosis of AARF and appropriate conservative treatment we can avoid surgery, even with conservative treatment from the onset of symptoms, five patients in our series required surgery because conservative treatment did not lead to successful reduction. When conservative treatment for chronic AARF patients fails, C1-2 transarticular fixation, and C1 lateral mass screw and C2 pedicle screw fixation are reliable methods to treat these patients.
六例患有慢性寰枢椎旋转固定（AARF）的儿科患者接受了后路固定。所有患者最初均接受保守治疗，如使用颈托、牵引、密涅瓦支具或头环背心；然而，由于C2关节面畸形或C1-2关节面融合，他们未能成功复位。我们使用C1侧块螺钉和C2椎弓根螺钉、C1-2经关节螺钉进行C1-2融合，或使用棒和钢丝系统进行枕颈融合。五例患者在最后一次随访时实现了牢固融合，无斜颈或颈部疼痛。一名患者术后有轻度斜颈但无疼痛。尽管我们认为早期诊断AARF并进行适当的保守治疗可以避免手术，但即使从症状出现就开始进行保守治疗，我们系列中的五例患者仍需要手术，因为保守治疗未能成功复位。当慢性AARF患者的保守治疗失败时，C1-2经关节固定以及C1侧块螺钉和C2椎弓根螺钉固定是治疗这些患者的可靠方法。
