钩状钛板在经颌下咽后入路手术治疗枢椎椎体疾患中的应用

Hook-plate instrument for C2 vertebral body disorders via submandiblar and retropharyngeal approach

目的:评价钩状钛板在经颌下咽后入路治疗枢椎椎体疾患中的应用价值。方法:2006年5月～2009年2月应用经颌下咽后入路手术治疗枢椎椎体疾患患者13例,枢椎爆裂骨折4例(2例合并C2/3椎间盘破裂,2例合并Ⅱ、Ⅲ型齿状突骨折),枢椎结核4例,枢椎肿瘤5例(2例良性肿瘤,3例转移瘤)。患者均有不同程度的枕颈部疼痛伴活动受限,均未发现有明显的神经功能障碍。枢椎爆裂骨折、结核和良性肿瘤患者病变处理后采用钩状钛板螺钉内固定植骨融合术,枢椎转移瘤患者病变处理后采用钩状钛板螺钉内固定骨水泥充填重建。结果:13例手术均顺利完成,手术时间90～140min,平均120min;手术出血量200～1250ml,平均380ml。术中无脊髓、重要神经及血管损伤。术后2例患者出现喝水呛咳、吞咽困难等喉上神经损伤症状,予对症治疗后1周时好转,1个月后神经功能恢复正常。切口均一期愈合。13例均获随访,随访时间6～32个月,平均18个月,10例进行植骨的患者在术后3～6个月(平均4个月)植骨均融合,所有病例未出现内固定松动和断裂。结论:经颌下咽后入路治疗枢椎椎体疾患时应用钩状钛板螺钉内固定能在完成病灶处理时一期前路重建脊柱稳定性,操作简便安全、固定可靠,创伤较小。

Objective：To evaluate the clinical effect of hook-plate system on the treatment of C2 vertebral body disorders via submandiblar and retropharyngeal approach.Method：Thirteen patients with C2 vertebral body disorders undergoing hook-plate instrumentation and bone graft or cement placement were reviewed retrospectively.There were 4 C2 burst fracture（2 with C2/3 disc rupture and 2 with type Ⅱ and Ⅲ odontoid fracture）,4 C2 tuberculosis,5 C2 tumor（2 benign and 3 malignant）.All patients presented with pain and malfunction of occipito-cervical region to various extent without any neurological deficits.Result：All operations were completed successfully,with the surgical time of 90 to 140min（mean,120min）,blood loss of 200 to 1250ml（mean,380ml）.No neurovascular iniury was noted.2 cases were complicated with superior laryngeal nerve deficit after operation,which resolved followed by conservative intervention for 1 month.All skin incision were healed primarily.13 cases were followed up with the mean of 18 months（range,6-32 months）,and 10 cases undergoing bony graft were evidenced bony union 4 months later（range,3-6 months）.No instrument failure was noted afterwards.Conclusion：Hook-plate instrument for C2 vertebral body disorders via submandiblar and retropharyngeal approach can perform debridement as well as stability reconstruction,which is reliable and less invasive.