经口切除齿状突同期后路内固定治疗齿状突畸形

Treatment of odontoid process malformation by odontoidectomy via transoropharyngeal approach and concurrent posterior internal fixation

目的探讨经口切除齿状突同期后路内固定手术治疗齿状突畸形的安全性及有效性。方法回顾性分析15例齿状突畸形病人的临床资料,均采用经口齿状突切除、同期后路内固定枕颈融合术。通过临床症状、影像学、稳定性等指标评价该手术方法的治疗效果和安全性。结果术后病人症状均有所改善,1例喉头水肿病人行气管切开后痊愈。影像学显示:畸形齿状突完全切除14例,齿状突部分残留1例。钉棒内固定系统位置良好。随访15例,时间3个月-2年,颅颈交界处稳定。结论经口齿状突切除可以有效改善病人症状,同期枕颈内固定融合技术能维持颅颈交界处的稳定性。

Objective To explore the safety and efficacy of odontoidectomy via transoropharyngeal approach and concurrent posterior internal fixation for odontoid process malformation. Methods Clinical data of 15 patients with odontoid process malformation were analyzed retrospectively, who underwent transoropharyngeal odontoidectomy and concurrent posterior internal fixation with occipitocervical fusion. The therapeutic efficacy and safety of this surgical technique were evaluated based on clinical symptoms, imaging and stability. Results The postoperative symptoms were improved in all the patients. Laryngeal edema occurred in 1 patient who underwent tracheotomy and recovered well. Imaging examination showed that total resection of odontoid process malformation was achieved in 14 patients and part of odontoid process with malformation remained in 1 patient. The position of the pedicle screw-rod internal fixation system was satisfactory. Fifteen patients were followed up for 3 month to 2 years, the craniocervical junction of all the patients were stable. Conclusions The clinical symptoms of patients with odontoid process malformation can be effectively ameliorated by odontoidectomy via transoropharyngeal approach. The concurrent occipitocervical internal fixation with fusion can maintain the stability and safety of the craniocervical junction.