新英格兰医学杂志的病例报告长什么样子？

病例报告往往是少见或者经典病例的报告。在我们泱泱大国，最不缺的就是病例。大家在临床工作中，需要善于发现，善于总结，善于发表。今天我们看看殿堂级医学期刊，新英格兰医学杂志的病例报告长什么样子。创伤性枢椎滑脱，亦称Hangman骨折，多由颈部过度牵拉引起的。骨折分类根据前后位移偏差程度、后纵韧带断裂是否存在、骨折线的位置以及有无小关节脱位。稳定骨折伴位移较小的情况可能通过外部固定进行保守治疗，但对于不稳定的骨折，正如这个患者，需要手术进行固定。该患者接受了C2和C3椎骨的前路融合术，并在随访4年后，该患者没有神经功能缺失以及疼痛。

Traumatic Spondylolisthesis of the Axis

Anis Khelifi, M.D., and Faycel Saadaoui, M.D.

N Engl J Med 2017; 376:1782DOI: 10.1056/NEJMicm1405867

A 25-year-old man presented to the emergency department with severe neck pain after he was involved in a high-speed collision between two vehicles. He had full strength in his arms and legs, normal sensation to light touch and pinprick, and no sphincter disorders. A lateral radiograph (Panel A) showed disruption of the intervertebral disk between the C2 and C3 vertebrae, posterior angulation of the C2 vertebra fragment, fracture of the left pedicle of the axis, and a small inferior anterior fragment (arrow). An axial computed tomographic scan (Panel B) confirmed that the right and left pedicles of the C2 vertebra were fractured. Traumatic spondylolisthesis of the axis, also known as a hangman’s fracture, is caused by hyperextension of the neck. These fractures are classified according to the degree of anteroposterior deviation, presence of disruption of the posterior longitudinal ligament, position of the fracture line, and presence of a facet-joint dislocation. Stable fractures with minimal displacement may be managed conservatively with external immobilization, but unstable fractures, as in this case, require surgical stabilization. The patient underwent anterior fusion of the C2 and C3 vertebrae, and at follow-up 4 years later, he had no neurologic deficits and was free from pain.

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