经高位咽后入路行上颈椎手术的治疗选择

Treatment of upper cervical spine injuries via the high anterior cervical retropharyngeal approach

目的观察经高位咽后入路行上颈椎前路手术的适应证选择及临床效果。方法本组男32例，女9例；年龄12～67岁，平均41岁。Hangman骨折21例，C2椎体骨折2例，先天性齿状突不连伴难复性寰枢椎脱位12例，C1,2椎体结核4例，C3骨巨细胞瘤2例。全部患者均采用高位前方咽后入路显露C1～C3，Hangman骨折和C2椎体骨折复位后行C2,3椎间盘切除植骨融合内固定；先天性齿状突不连行前路松解复位、后路寰枢融合；结核行病灶清除，肿瘤行切除重建。创伤患者脊髓损伤按美国脊髓损伤学会（ASIA）标准评定，非创伤患者依据日本骨科学会（JOA）评分、Odom标准评定神经功能。结果41例患者均成功显露C1前弓～C3椎体，骨折患者行复位减压融合内固定；结核、肿瘤患者行病灶切除重建。创伤患者脊髓功能正常者无神经功能损害，不全瘫患者神经功能均有部分恢复。非创伤患者神经功能有明显改善，JOA评分由术前8．9分增加至12．5分；Odom评分临床成功率（优／良／可）达到94％。3例出现舌下神经牵拉症状，2例出现面神经刺激症状，无伤口感染。结论前方高位咽后入路可充分显露上颈椎，完成复位减压和稳定重建，并最大限度重建颈椎生理功能。

Objective To study the indications and clinical outcome of the upper cervical spine via the high anterior cervical retropharyngeal approach in treatment of upper cervical spine injuries. Methods There were 41 patients including 32 males and 9 females, at age of 12-67 years. Of all patients, there were 21 patients with Hangman fractures, two with fracture of C2 vertebral body, 12 with irreducible atlantoaxial dislocation secondary to as odontoideum, four with C1.2 tuberculosis and two with C2 gaint cell tumor. All patients underwent the high anterior cervical retropharyngeal approach to expose C1 - C3. C2,3 fusion followed by self-locking plate was performed for Hangman fractures and C2 fractures. Ven- tral reduction plud posterior atlantoaxial fusion was done for irreducible atlantoaxial dislocation secondary to as odontoideum. Lesion was cleared for tuberculosis and the tumor was rcseeted and reconstructed. The neurological funcation was evaluated according to the ASIA criteria, the JOA score and Odom＇ s criteria. Results Successful exposure of arch of atlas to C3 was achived in all 41 patients, with satisfactory reducation, decompression, fusion, lesion resection and reconstruction. The trauma patients with normal neurological function showed no neurological deficit postoperatively, but those with quadriparesis had partial recovery. While the patients with illness obtained marked recovery of neurological function, with the JOA score from preoperative 8.9 to 12.5 at final follow-up. The clinical success rate （excellent/good/fair） reached 94. % according to Odom＇s Criteria. Hypoglossal symptom was found in three patients and facial nerve symptom in two, without wound infection. Conclusions Via the high anterior cervical retropharyngeal approach, the upper cervical spine can be thoroughly exposed to facilitate reduction, decompression and reconstruction and maximally restore physiological function of the cervical spine in treatment of the upper cervical spine injuries.