高位前方咽后入路手术治疗上颈椎疾病

Surgical treatment of upper cervical vertebra disease from high anterior cervical retropharyngeal approach

目的探讨经高位前方咽后入路手术治疗上颈椎疾病的临床效果。方法本组14例,C_(2、3)椎间盘突出伴C_(2、3)脱位7例,Hangman骨折3例,齿状突骨折2例.C_3椎体肿瘤2例。采用高位前方咽后入路,10例行C_(2～3)椎间盘切除或C_3椎体病灶清除+自体髂骨或钛网融合器植入+颈前路钢板内固定术,2例行齿状突中空螺钉内固定术。结果14例患者术中均清楚显露C_1前弓～C_(2、3)椎体前方.完成减压复位、病灶清除、融合内固定等操作;无颈部重要血管神经损伤;有脊髓压迫者术后脊髓神经功能得到一定程度的改善。结论经高位前方咽后入路可充分显露上颈椎前方,进行直接有效的手术操作,创伤小,并发症少.是理想的显露途径。

Objective To study the clinical result of the surgical treatment of upper cervical vertebra disease from high anterior cervical retropharyngeal approach. Methods Among 14 patients,there were 7 C2、3 disc herniations combined with C2、3 dislocations,3 Hangman fractures,2 odontoid process fractures and 2 C3 tumors. All patients underwent the high anterior cervical retropharyngeal approach. 10 cases were given discectomy of C2、3 or focus clearance of C3,iliac bone autograft or titanium cage filled and internal fixation with titanium plate. 2 cases of odontoid process fractures were given anterior screw fixation. Results 14 cases got successful exposure. The decompression, reduction, lesion clearance and fusion with internal fixation were done in all patients. There were no important vascular or nerve injuries. The surgical treatment could improve the spinal cord nerve function to a certain degree for the cases with compression of spinal cord. Conclusion Good exposure of upper cervical spine and effective surgical operation could be achieved from high anterior cervical retropharyngeal approach,with minimal trauma and complication, and it was a favorable approach.