枕寰区腹侧病变的外科治疗

Transoccipitocervical posterolateral approach to excise deformed odontoid process of C2

目的 :探索一种新的治疗枕寰区腹侧病变的手术方法。方法 :对 31例枕寰区病变患者 (枕寰区畸形 2 3例 ,齿状突陈旧性骨折伴寰枢脱位 8例 )采用经枕颈后外侧入路先行枕骨大孔扩大及寰椎后弓切除减压 ,然后经枕颈区硬脊膜侧方显露齿突及C2椎体的后方 ,达到脊髓前、后方同时减压并一期植骨枕颈融合。结果 :全组病例无术中死亡及术后感染。 1例术后 10d作石膏外固定时突然呼吸停止死亡。余 30例术后随访 6～ 2 4个月 ,患者躯体感觉恢复接近正常 ,四肢肌张力明显降低 ,肌力均有 1级以上改善。结论 :该术式手术视野开阔 ,脊髓前、后方减压及枕颈融合可一期完成 。

Objective:To explore a new approach to odontoid process of C2 for occipitocervical anomaly.Method:After reserching the anatomy of occipitocervical region,through transoccipitocervical posterolateral approach occipital foramen magnum was enlarged and posterior arch of atlas was excised.Then by way of translateral aspect of dura mater of spinal cord,odontoid process of C2 and posterior aspect of axis were exposed.Deformed odontoid process could be excised by high speed drill.From February 1997 to February 2000,31 cases with occipitocervical anomalies were treated in transoccipitocervical posterolateral approach to excise odontoid process of C2.Occipitocervical fusion were performed in 5 cases at the same time.Result:There were no death during operation and postoperative infection in all cases.The period in follow up ranged from 6～18 months,It revealed that sensory function of all cases restored nearly to normal and muscular tension of four limbs decreased after operation.Muscular strength of four limbs increased more than one degree in all cases.Process of axis was exposed very clearly and operation region was wide in this new approch.Anteroposterior decompression and occipitocervical fusion were performed at the same time.So it is belived this operative approach is a new ideal one to treat disorders of ventral aspect of spinal cord in occipitocervical region.