经颈侧前入路行高位颈椎前方暴露及操作

The exposure and manipulation of the high cervical spine through the anterior lateral cervical approach

目的 探讨经颈侧前入路行高位颈椎减压以及内固定的显露效果。方法 以下颌角平面为中心沿胸锁乳突肌前缘作 5cm切口。在切口下端向内牵开气管、食管 ,向外牵开颈动脉鞘从而显露C4,并沿间隙向上方分离显露C1～ 3 ,最后将颈长肌、头长肌从椎体前面向两侧牵开显露高位颈椎前方。在切口内完成C1,2 间纤维瘢痕切除松解以及C2 ,3 间骨折切开复位、椎间盘摘除、病灶清除、椎间植骨、自锁钢板内固定等操作。结果 11例患者均成功显露出C1～ 4椎体前方及椎间盘 ,并完成椎间松解术、病灶清除术、减压融合内固定术 ;无颈部重要结构损伤 ,1例患者有一过性声嘶 ,患者术后的感觉、肌力均有所恢复。结论 经颈侧前方入路可显露高位颈椎前方 ,损伤小、显露简单充分、且切口并发症少 ,为较理想的暴露途径。

Objective To study the exposure effect of the high cervical spine through the anterior lateral cervical approach for cervical decompression and internal fixation. Methods At the level of mandible anagle, the incision is about 5 cm long in the anterior side of sternoclavicular muscle. Retract the trachea and esophagus medially and the carotid sheath laterally, and the C 4 is exposed. Separate the tissue in this space upward until the C 1～3 are exposed. And finally retract the longus colli muscles and longus capitis muscles laterally to expose the high cervical vertebra. The surgery can be done through this approach, such as scar release between the C 1 and C 2, fracture reduction of C 2,3 ; discectomy; focus clearance, intervertebral bone graft, and auto-locking steel plate fixation. Results 11 cases got successful exposure of the C 1～C 4. The decompression and fusion were done in all patients. There was no important vascular and nerve injury or wound infection. 1 case got transient hoarseness. All cases got sense and myodynamia recovery in different degree. Conclusion The anterior lateral cervical approach is effective in the high cervical spine surgery with simple full exposure and minimal wound complication, so it is a favorable approach.