上位颈椎前路手术咽后入路“窗口”显露技术的临床应用观察

The "window" surgical exposure strategy of the upper anterior cervical retropharyngeal approach for anterior decompression at upper cervical spine

目的:探讨上颈椎前路减压经咽后入路"窗口"显露技术在上颈椎损伤手术中的应用。方法:2000年1月至2008年7月手术治疗上位颈椎损伤患者5例,男4例,女1例;年龄16～68岁,平均35岁。C2椎弓骨折(HangmanⅡ型)2例,C2,3椎间盘突出症2例,C2椎体结核1例。所有患者经高位前方咽后入路舌下神经、喉上神经、咽和颈动脉之间的"窗口"成功获得显露。Hangman骨折复位后行C2,3椎间盘切除椎间植骨融合内固定。C2,3椎间盘突出症患者行相应椎间盘切除,减压植骨融合内固定。C2椎体结核行病灶清除并植骨等。结果:5例患者均成功在舌下神经、喉上神经、咽和颈动脉之间的"窗口"显露出C1前弓-C3椎体。随访5～26个月,平均13.5个月。无伤口感染,无颈部重要血管神经损伤。患者的神经症状恢复良好,所有患者植骨都获得了融合。结论:前方咽后入路的"窗口"显露技巧可使上颈椎获得理想的显露,创伤小,切口并发症少,有相关经验后也比较安全。

Objective：To investigate the ＂window＂ surgical exposure strategy of the upper anterior cervical retropharyngeal approach for the exposure and decompression and instrumentation of the upper cervical spine. Methods：From Jan. 2000 to July. 2008,5 patients with upper cervical spinal injuries were treated by surgical operation included 4 males and 1 female with and average age of 35 years old ranging from 16 to 68 years. There were 2 cases of Hangman＇s fractures（typeⅡ）,2 of C2,3 intervertebral disc displacement and 1 of C2 vertebral body tuberculosis. All patients underwent the upper cervical anterior retropharyngeal approach through the＂window＂between the hypoglossal nerve and the superior laryngeal nerve and pharynx and carotid artery. Two patients of Hangman＇s fractures underwent the C2,3 intervertebral disc discectomy,bone graft fusion and internal fixation. Two patients of C2,3 intervertebral disc displacement underwent the C2,3 intervertebral disc discectomy,decompression bone graft fusion and internal fixation. One patient of C2 vertebral body tuberculosis was dissected and resected and the focus and the cavity was filled by bone autografting. Results：C1 anterior arch to C3 anterior vertebral body were successful exposed. Lesion resection or decompression and fusion were successful in all patients. All patients were followed-up for from 5 to 26 months （means 13.5 months）. There was no important vascular and nerve injury and no wound infection. Neutral symptoms was improved and all patient got successful fusion. Conclusion：The＂window＂surgical exposure surgical technique of the upper cervical anterior retropharyngeal approach is a favorable strategy. This approach strategy can be performed with full exposure for C1-C3 anterior anatomical structure,and can get minimally invasive surgery results and few and far between wound complication,that is safe if corresponding experience is achieved.