Riouallon G, Pascal-Moussellard H
Service de chirurgie orthopédique et traumatologie, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013, Paris, France; Faculté de Médecine Pierre et Marie-Curie, Site La Pitié, 91 et 105, boulevard de l'Hôpital, 75634 Paris, France.
Service de chirurgie orthopédique et traumatologie, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013, Paris, France; Faculté de Médecine Pierre et Marie-Curie, Site La Pitié, 91 et 105, boulevard de l'Hôpital, 75634 Paris, France.
Orthop Traumatol Surg Res. 2014 May;100(3):341-5. doi: 10.1016/j.otsr.2013.12.026. Epub 2014 Apr 13.
A case of traumatic posterolateral C1-C2 dislocation associated with odontoid fracture is reported. This is a rare case of traumatic posterolateral C1-C2 dislocation associated with odontoid fracture. Its management is discussed. A traumatic dislocation of atlanto-axial joint associated with an odontoid fracture remains a rare injury. No case of posterior dislocation has been reported so far in the literature with this type of management. The case is of a 25 year-old-man with a primary atlanto-axial posterolateral dislocation associated with a type II displaced odontoid fracture without any neurological complication. The patient underwent gentle traction during 24 hours with a halo frame. An incomplete reduction was achieved. Two days later, a complete reduction was obtained thanks to a preoperative manual traction maintained by a Mayfield (R) modified skull clamp. Anterior C1-C2 fixation was performed according to Vaccaro's technique. The patient wore a cervical collar and underwent physiotherapy during three months. To our best knowledge, this case represents the first traumatic atlanto-axial dislocation associated with an odontoid fracture which was treated through retropaharyngeal approach. This had been rendered possible thanks to the final reduction maneuver in extension.
报告了一例伴有齿状突骨折的创伤性C1-C2后外侧脱位病例。这是一例罕见的伴有齿状突骨折的创伤性C1-C2后外侧脱位病例。文中讨论了其治疗方法。寰枢关节创伤性脱位合并齿状突骨折仍然是一种罕见的损伤。目前文献中尚未报道过采用这种治疗方式的后脱位病例。该病例为一名25岁男性，原发性寰枢后外侧脱位，伴有II型移位齿状突骨折，无任何神经并发症。患者在头环固定下进行了24小时的轻柔牵引，实现了不完全复位。两天后，由于采用梅菲尔德（R）改良颅骨夹维持术前手法牵引，实现了完全复位。根据瓦卡罗技术进行了C1-C2前路固定。患者佩戴颈托并接受了三个月的物理治疗。据我们所知，该病例是首例通过咽后入路治疗的伴有齿状突骨折的创伤性寰枢脱位。由于最终的伸展复位操作，才得以实现这一治疗。
