斜頚を呈した小児上位頚椎疾患における術中3Dイメージの有用性

Effectiveness of Intraoperative 3D Imaging of Upper Cervical Disorders in Children with Torticollis

　背景：斜頚を呈する小児上位頚椎疾患の麻酔下徒手整復は，透視下で整復しCTでの確認を要する．被曝が問題となり，この問題を解決するARCADIS Orbic 3Dによる術中3Dイメージの有用性について報告する．

　対象と方法：保存治療が無効のsplit atlasと環軸椎回旋位固定の2例に全身麻酔下徒手整復を行い，術中3Dイメージを撮影した．

　結果：多断面再構築画像・3D画像で整復位を確認し，ハローベスト固定とした．2例とも再発・可動域制限を認めていない．

　まとめ：術中3Dイメージは，被曝線量も低く術中に整復位を確認できる有用な画像ツールである．

　Background：We performed intraoperative 3-dimensional (3D) radiographic imaging with an ARCADIS Orbic 3D system of upper cervical disorders in children being surgically treated for torticollis.

　Materials and Methods：We report our experience with 3D imaging in two cases.　The first case was in a patient with a rotatory dislocation in the sagittal plane and a split atlas that involved defects in both the anterior arch and posterior arch.　The other case was in a patient with atlantoaxial rotatory fixation (AARF).　When conservative treatment in these two patients failed, we decided to perform manual reduction under general anesthesia and obtained intraoperative 3D images with a C-arm imaging system.

　Results：Reduction was confirmed by multiplanar reconstruction (MPR) imaging and 3D imaging, and was followed by halo-vest fixation.　No recurrence of the torticollis or limitation of range of motion has been observed postoperatively.

　Conclusion：Intraoperative 3-D imaging was a useful tool for confirming manual reduction in the operating room.