Smith-Robinson入路在C_(2/3)节段手术中的应用

Application of Smith-Robinson approach for C_(2/3) cervical spine surgery

目的总结Smith-Robinson入路(SR入路)应用于C2/3节段手术的经验。方法回顾性分析36例C2/3节段SR前路手术的患者资料,患者年龄21～72岁,平均(47±13.5)岁;男25例,女11例。其中Hangman骨折35例,C2/3创伤性椎间盘突出1例。合并伤包括颅脑外伤10例,面部软组织挫伤22例,腰椎骨折1例,四肢骨折6例,内脏挫裂伤2例;合并症包括强直性脊柱炎1例。结果 36例均通过SR入路实施C2/3单节段手术,其中34例行Cage+前路钢板内固定,2例行自体髂骨块+前路钢板内固定。所有手术均顺利完成。随访6～32个月,平均随访时间(9.1±2.8)个月。1例(2.4%)患者术后出现饮水呛咳,3个月后自行消失。术前10例患者有不同程度神经功能障碍,术前Japanese Orthopaedic Association Scores(JOA)评分13.10±3.35,术后JOA评分15.70±1.49,改善率(74±23)%。所有患者均获得植骨融合。结论 SR入路可用于C2/3节段手术,具有操作简便、局部解剖清晰、并发症少等优点;但下颌骨大、肌肉健壮的患者采用这一入路有一定困难。

Objective To summarize our experience in using Smith-Robinson approach（SRA） for level C2/3 cervical spine surgery.Methods The clinical data of 36 patients receiving SRA for level C2/3 cervical spine surgery were retrospectively analyzed.The patients included 25 males and 11 females,with an average age of（47±13.5） years（range： 21-72 years）.Thirty-five cases had Hangman fracture and one had traumatic disc herniation at C2/3.Combined injury included head injury（10 cases）,soft tissue injury on the face（22 cases）,fracture at lumbar spine（1 case）,extremities fracture（6 cases） and injury of inner organs（2 cases）.One patient had ankylosing spondylitis.Results C2/3 discetomy procedures were performed satisfactorily in all the 36 cases,with cages plus anterior plate fixation used in 34 cases and iliac bone plus anterior plate fixation in 2 cases.The patients were followed up for（9.1±2.8） months（ranging 6-32 months）.One patient（2.4%） had choking and trouble in swallowing liquids,and the symptom disappeared 3 months later without any treatment.Neurological dysfunction was observed in 10 cases before operation,with the average JOA scope being（13.10±3.35） pre-operation and（15.70±1.49） post-operation,showing an improving rate of（74±23）%.Fusion was achieved in all cases during follow-up.Conclusion SRA can be applied at level C2/3 cervical spine surgery;the procedure is simple,with clear surgical field and less complication.Patients with large chin or extremely strong muscle may not be indicated for this approach.