Sof'wire Cable systemにて良好な固定が得られたJefferson骨折の1手術例

A case of Jefferson fracture treated with the Sof'wire Cable system method of fixation

I．はじめに

　Jefferson fractureとは，atlasに長軸方向の外力が加わったとき，前弓・後弓の両側の骨折に伴い，lateral massが左右に転位したものである．1920年Jefferson^10）がこのタイプの骨折の受傷機転を力学的に解析したため，以降Jefferson fractureとされるに至った．Jeffer—son骨折は稀な疾患であり頸椎骨折の2-13％，また全脊椎骨折の1.3％にすぎない^15），今回われわれは交通事故にて受傷した患者にSof'wire Cable systemと腸骨を使用して後方固定術を施行し良好な結果を得たので報告する．

Jefferson fracture is a very rare disease which occurs in only 2-13% of all cervical spinal fracture cases and in only 1.3% of total spinal fracture cases. A combina-tion of an atlas-axis fracture occurs relatively frequently and with a higher incidence of neurological morbidity than isolated fractures. However, a Jefferson fracture, which is an isolated C-1 fracture, occurs very rarely.

A 58-year-old woman was involved in a traffic acci-dent and admitted to our hospital. She had a large scalp laceration in the parietal region and complained of nuchal pain. Neurological examination revealed no-thing abnormal. A cervical x-p (lateral view) revealed no abnormal findings, but an open-mouth view revealed an 8 mm displacement (in total) in the lateral mass of the atlas. A cervical CT revealed a Jefferson fracture.Crutchfield traction was performed for 9 days followed by external immobilization with a halo-vest to allow the patient to be ambulatory quickly. A posterior occipi-tocervical fusion was performed with an iliac bone autograft using the Sof'wire Cable system for late cer-vical stability and reducing the period of rigid external immobilization. The postoperative state was uneventful. The halo-vest was removed 10 weeks after surgery. An x-p obtained 3 months postoperatively showed good stability of the cervical spine. The Sof'wire Cable sys-tem proved to be very useful.