Hettiaratchy S, Ning C, Sabin I
Department of Neurosurgery, Royal London Hospital, England.
Neurosurgery. 1998 Jul;43(1):162-4; discussion 164-5. doi: 10.1097/00006123-199807000-00110.
Concomitant atlantoaxial and atlanto-occipital subluxation resulting from any cause is extremely rare. We have found only five previously reported cases and describe another, suggesting a treatment plan.
A 13-year-old female patient presented with a 3-month history of neck pain and decreased neck movements. All symptoms started after a localized neck infection had been treated successfully with antibiotics. There was no history of trauma. A diagnosis of postinfective atlanto-occipital and atlantoaxial rotatory subluxation was made based on a plain roentgenogram and was confirmed based on a computed tomographic scan.
The atlantoaxial and atlanto-occipital subluxation was reduced during surgery. A posterior C1-C2 fixation was performed, and the atlanto-occipital joint was stabilized by means of a halo body jacket for 3 months. One year after removal of the jacket, all subluxation remained reduced and the patient retained significant neck movement.
Disruption of the occipito-atlanto-axial complex can result from relatively minor head and neck infections and should be suspected in children with persisting neck pain and decreased neck movements. It may not be necessary to perform an occipitoaxial fusion to treat these patients, and a more limited fusion may be successful.
由任何原因导致的寰枢椎和寰枕关节同时半脱位极为罕见。我们仅发现了五例先前报道的病例，并描述了另一例，同时提出了一个治疗方案。
一名13岁女性患者有3个月的颈部疼痛及颈部活动减少病史。所有症状均在局部颈部感染经抗生素成功治疗后出现。无外伤史。根据X线平片诊断为感染后寰枕关节和寰枢椎旋转半脱位，并经计算机断层扫描确诊。
手术中对寰枢椎和寰枕关节半脱位进行了复位。实施了C1 - C2后路固定，并用头环背心固定寰枕关节3个月。去除背心一年后，所有半脱位均保持复位状态，患者颈部活动明显恢复。
枕寰枢复合体的破坏可能由相对轻微的头颈部感染引起，对于持续颈部疼痛和颈部活动减少的儿童应予以怀疑。治疗这些患者可能无需进行枕颈融合术，更有限的融合术可能会成功。
