Matsuyama Yoshiyuki, Ishikawa Tetsuhiro, Ozone Ei, Aramomi Masaaki, Ohtori Seiji
Orthopaedic Surgery, Sanmu Medical Center, 167 Naruto, Sanmu, Chiba 289-1326, Japan.
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
Case Rep Orthop. 2017;2017:1017307. doi: 10.1155/2017/1017307. Epub 2017 Dec 26.
In cases of chronic irreducible and recurrent unstable atlantoaxial rotatory fixation (AARF), closed reduction and its maintenance are often unsuccessful, requiring surgical treatment. The purpose of the present report is to describe a rare case of pediatric AARF that required multiple treatments. A 6-year-old boy was diagnosed as having type 2 AARF. After conservative treatment, the patient was treated with temporary fixation surgery (C1-C2 Magerl) without a bone graft in consideration of motion preservation after screw removal. AARF recurred after the screw removal and required fusion surgery (Magerl-Brooks) with an iliac bone graft. Ultimately, bone union was achieved and the screws were removed 11 months after the surgery. We recommend surgeons be cautious when choosing temporary fixation surgery for AARF in small children. Further investigation is needed to determine the optimal time before screw removal.
在慢性不可复位且复发性不稳定的寰枢椎旋转固定（AARF）病例中，闭合复位及其维持往往不成功，需要手术治疗。本报告的目的是描述一例罕见的需要多次治疗的小儿AARF病例。一名6岁男孩被诊断为2型AARF。经过保守治疗后，考虑到螺钉取出后的活动保留，对该患者进行了无植骨的临时固定手术（C1-C2马格勒固定）。螺钉取出后AARF复发，需要进行带髂骨植骨的融合手术（马格勒-布鲁克斯手术）。最终实现了骨愈合，术后11个月取出了螺钉。我们建议外科医生在为小儿AARF选择临时固定手术时要谨慎。需要进一步研究以确定螺钉取出的最佳时间。
