ハローベスト固定で治療した小児環軸椎回旋位固定の 1 例

概要

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Atlantoaxial rotatory fixation (AARF) can occasionally occur after trauma or pharyngeal infection in children, causing torticollis, limited neck motion, and neck pain. The mechanism responsible for AARF is not fully understood, but may be due to the immature joint structure seen in children. The causes of irreducible subluxation or recurrence are muscle spasm and ligamentocapsular contractures, synovial fringes, and deformity of the superior facet of the axis. We have experienced a pediatric case of AARF that was resistant to conservative treatment. The patient, a 7-year-old girl, had been infected with mumps and developed torticollis a month before presentation. She had been seen at a local clinic and diagnosed as having AARF, which was then treated conservatively without any response. She was therefore brought to our hospital to undergo Glisson traction. As torticollis still remained, we performed closed manipulation under general anesthesia. 3D CT showed a C2 facet deformity. One month after halo fixation, remodeling of the C2 facet deformity was observed. Two months after halo fixation, the remodeling had advanced and the appearance had begun to resemble that on the normal side, and therefore we removed the halo vest and installed a Philadelphia collar. One month later, we removed the Philadelphia collar, and since then (one year later) the torticollis has not recurred.
中国・四国整形外科学会の論文