Cooper P R, Maravilla K R, Sklar F H, Moody S F, Clark W K
J Neurosurg. 1979 May;50(5):603-10. doi: 10.3171/jns.1979.50.5.0603.
Thirty-three patients with a spectrum of cervical spine fractures or subluxations were treated with immobilization by a halo apparatus. All spines were assumed to be unstable because of the nature of the fracture or because of a subluxation noted on spine films. Treatment consisted of immobilization and fracture reduction followed by application of a halo plaster cast or molded halo plastic vest. Patient acceptance was high. Complications were few and minor. No patient experienced neurological deterioration during treatment. Reduction was well maintained during an average halo immobilization period of over 3 months. Use of the halo resulted in healing of bone and ligament and restoration of stability in 85% of the patients. Halo immobilization was efficacious in the treatment of odontoid and hangman's fractures as well as complex fractures involving multiple areas of a single vertebra. It was also used successfully as an adjunct to posterior cervical fusion. Although several patients with subluxations or angulation without bone injury were treated successfully, two of the four therapy failures occurred in this group of patients, and the halo must be used with caution in this clinical setting. Contraindications to the use of the halo include complete cervical spinal cord injury with anesthetic skin, tomographic and/or myelographic evidence of disc or bone within the spinal canal, and unsatisfactorily reduced subluxations. The halo has provided more effective and reliable immobilization than other orthoses. It is an acceptable alternative to cervical fusion for the achievement of stability in a wide variety of cervical spine fractures and dislocations avoiding both the short-term and perhaps long-term complications of spinal fusion.
33例患有各种颈椎骨折或半脱位的患者采用头环装置固定治疗。由于骨折的性质或脊柱X线片上显示的半脱位，所有脊柱均被认为不稳定。治疗包括固定和骨折复位，随后应用头环石膏管型或模制头环塑料背心。患者接受度高。并发症少且轻微。治疗期间无患者出现神经功能恶化。在平均超过3个月的头环固定期内，复位情况维持良好。使用头环使85%的患者实现了骨和韧带愈合以及稳定性恢复。头环固定在治疗齿状突骨折、绞刑者骨折以及累及单个椎体多个部位的复杂骨折方面有效。它还成功用作颈椎后路融合术的辅助手段。尽管有几名无骨损伤的半脱位或成角患者治疗成功，但4例治疗失败中有2例发生在这组患者中，在这种临床情况下使用头环必须谨慎。使用头环的禁忌证包括伴有感觉缺失皮肤的完全性颈脊髓损伤、椎管内椎间盘或骨的断层扫描和/或脊髓造影证据以及复位不满意的半脱位。头环提供了比其他矫形器更有效、更可靠的固定。它是颈椎融合术的一种可接受的替代方法，可在多种颈椎骨折和脱位中实现稳定性，避免脊柱融合的短期和可能的长期并发症。
