外傷性環椎後頭骨脱臼の1生存例

Traumatic atlanto-occipital dislocation:a case report with survival

I．はじめに

　外傷性環椎後頭骨脱臼（atlanto-occipital disloca—tion：AOD）は一般に脳幹部圧迫を伴うため致死的となることが多かったが，近年救急医療体制の充実に伴い生存例も報告されてきている．最近われわれはその1生存例を経験したので文献的考察を加えて報告する．

We reported a case of a patient who survived anterior atlanto-occipital dislocation. A seven-year-old girl was admitted to our hospital clue to disturbed consciousness after being involved in a traffic accident. With gradual improvement of consciousness, she showed bilateral abducens nerve palsy, quadriparesis and cervical insta-bility. Lateral plain film showed anterior atlanto-occipital dislocation. MRI showed severe compression of the cervical cord and disruption of supporting liga-ments of the cervicomedullary junction. After 4 months, cervical instability continued and posterior fixation was carried out with bone grafts. Her postoperative course was uneventful.