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Hadassah surgeons reattach boy’s head to his neck after internal decapitation
In an extremely rare and complex operation, Hadassah Medical Center surgeons have reattached a 12-year-old boy’s head to his neck after a serious accident in which he was hit by a car while riding his bicycle, the Jerusalem hospital announced on Wednesday.
Suleiman Hassan, a Palestinian from the West Bank, was airlifted to Hadassah hospital’s trauma unit in Ein Kerem, where it was determined that the ligaments holding the posterior base of his skull were severely damaged, leaving it detached from the top vertebrae of his spine. The condition, bilateral atlanto occipital joint dislocation, is commonly known as internal or orthopedic decapitation.
The injury is very rare in adults, and even more so in children.
“We fought for the boy’s life,” said Dr. Ohad Einav, the orthopedic specialist who operated on the patient together with Dr. Ziv Asa and a large operating room and intensive care team. The surgery was carried out in early June.
“The procedure itself is very complicated and took several hours. While in the operating room, we used new plates and fixations in the damaged area… Our ability to save the child was thanks to our knowledge and the most innovative technology in the operating room,” Einav said.
Einav, who returned to Israel a year ago after a fellowship at trauma centers in Toronto, estimated that this rare injury has occurred in Israel before. As far as he is aware, he is one of just a few surgeons in Israel who specialize in trauma surgery for spinal injuries.
Hassan was recently discharged home with a cervical splint and will continue to be carefully monitored by the Hadassah staff.
“The fact that such a child has no neurological deficits or sensory or motor dysfunction, and that he is functioning normally and walking without an aid after such a long process, is no small thing,” Einav said.
A Children’s Hospital of Philadelphia report from 2003 stated that of the 2006 patients it treated for spinal cord injuries between 1983 and 2003, only 16 suffered from occipital joint dislocation.
“The injury is extremely rare, but we do know that because children between ages four and 10 have heads that are large in relation to their bodies, they are more susceptible than adults,” Einav said.
The survival rate of those who suffer internal decapitation is low. In most cases, the injury results in death. There is evidence that children fare better than adults, but there is not yet enough data comparing children to adolescents.
A 2021 survey of studies on the injury in children and adolescents found that 55% do not survive the initial injury, transport to the hospital, surgery, and recovery.
The hospital reported that Hassan’s father did not leave his bedside during his recovery from surgery.
“I will thank you all my life for saving my dear only son. Bless you all. Thanks to you he regained his life even when the odds were low and the danger was obvious. What saved him were professionalism, technology and quick decision-making by the trauma and orthopedics team. All I can say is a big thank you,” he told the medical staff.
Einav said that his having performed this surgery on adults as part of his training in Toronto prepared him to operate on young Hassan.
“This is not a common surgery at all, and especially not on children and teens. A surgeon needs knowledge and experience to do this,” he said.
注释：
airlift: v
表示" 空运"，means "fly people or goods to or from places not accessible by other means;"，如：The army has been able to airlift many survivors to safety by helicopter.军队已经能够以直升机空运许多幸存者到安全地区。
ligament: n
表示" 韧带；连接物"，means "a sheet or band of tough fibrous tissue connecting bones or cartilages or supporting muscles or organs"，如：I had a deep bone bruise and damaged ligaments. 我骨头擦伤，韧带受伤。
posterior： n
表示" 臀部"，means "the fleshy part of the human body that you sit on"，如：A team of British academics has developed a mathematical formula to determine just how perfect your posterior is. 一个英国的学者小组发明一个能决定完美臀部的数学公式。
vertebrae: n
表示" [解]椎骨"，如：A mouse has the same number of neck vertebrae as a giraffe does. 老鼠和长颈鹿的颈椎骨数目相同。
occipital: adj
表示" 枕骨的；枕部"，means "of or relating to the occiput"，如：The occipital protuberance was well developed.枕骨隆突明显突出。
Dislocation：n
表示" [医]脱臼；"，means "a displacement of a part (especially a bone) from its normal position (as in the shoulder or the vertebral column)"，如：He came in the hospital with a dislocation of the shoulder.他因肩关节脱臼而住院。
orthopedic： adj
表示" 整形外科的"，means "of or relating to orthopedics"，如：Patients recovering from broken limbs are housed in the hospital's orthopedic ward.病人们住在医院整形外科的病房以恢复他们残损的肢体。
fixation: n
表示" 固定；"，means "the activity of fastening something firmly in positio"，如：We received some documentation on dune fixation. 我们收到了一些关于沙丘固定的资料。
cervical: adj
表示" 颈（部）的"，means "relating to or associated with the neck"，如：You have problem with your cervical vertebra. 您患的是颈椎病。
splint: n
表示"夹板"，means "an orthopedic mechanical device used to immobilize and protect a part of the body (as a broken leg)"，如：She wore a metal splint on one leg. 她的一条腿上上了金属夹板。
sensory: adj
表示"感觉的；"，means "involving or derived from the senses"，如：Changes in sensory perception are the most sensitive indicators of the presence of nitrogen dioxide. 感觉的改变是二氧化氮存在的最灵敏的标志。
中文简要说明：
以色列医界最近完成一件「断头接回」的罕见创伤个案治疗，传为美谈。一名12岁巴勒斯坦少年骑脚踏车遭汽车撞上，颈部韧带几乎全断，颅底与颈椎顶端分离，经过一群外科医师合作救治，「断头」成功接回，如今已能靠自己行走无虞。
《以色列时报》报导，这名幸运少年名叫苏雷曼（Suleiman Hassan），来自约旦河西岸，他的颈部因车祸严重受损，紧急送往位于耶路撒冷恩克润区（Ein Kerem）的哈达萨医学中心（Hadassah Medical Center）救治。哈达萨医学中心医疗团队发现，支撑颅底后端的韧带因突然撞击严重断裂，导致颅部与脊椎顶端几乎彻底分离。这种创伤在医学上称为「双侧寰枕关节脱臼」（bilateral atlanto occipital joint dislocation），也称为「体内断头」（internal decapitation），成人与儿童均属罕见伤害。
院方在6月初替少年开刀，但直到7月5日才宣布手术成果。苏雷曼已于日前出院返家，身上还装着颈椎夹板，日后会持续复健并接受医疗团队的仔细追踪。
哈达萨医学中心骨科医师表示，团队为了少年的生机全力搏斗，院方为了这场复杂手术筹组大型手术团队与加护医疗团队。专长脊椎伤害创伤手术的医师埃纳夫（Ohad Einav）说，手术非常复杂，花了好几个小时执行，使用新型骨板与固定术式，靠着团队的医学知识与开刀房最先进的技术，让这场复杂的手术成功。
2022年才从加拿大多伦多的创伤医学中心完成研究返回以色列的埃纳夫强调，苏雷曼术后并无神经功能缺损，也没有动作失调的情形，目前身体机能正常且不需辅助即可行走，「这绝非小事一桩」。他在多伦多研修期间也曾对成人患者执行这种手术，这项经历对于医治苏雷曼很有帮助，毕竟手术前例很少。
美国费城儿童医院2003年曾有报告指，1983年至2003年诊治的2006名脊椎损伤患者之中，仅16人是寰枕关节脱臼。埃纳夫说，这种伤势非常少见，不过，4岁至10岁的儿童因为头部相对于躯干而言比较大一些，这个部位比成年人更容易出现损伤。英国《每日邮报》指，寰枕关节脱臼在所有脊椎创伤占比不到1%，2015年有报告指，孩童发生率是成人的3倍有余。
「体内断头」伤者存活率低，绝大多数情况下，这种创伤会导致死亡。有证据显示儿童患者预后优于成人，但儿童与青少年的预后比较信息仍不足。2021年有研究调查显示，儿少遭受这种罕见创伤之后，55%在受伤之初、送院、手术与术后恢复期死亡。
苏雷曼手术与术后休养期间，他的父亲守在病床前寸步不离：「独子小命保住，对于医院所有人，我终身心怀感谢。」
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