经口咽入路单节段固定治疗不稳定性寰椎骨折的研究进展

寰椎骨折是常见的颈椎骨折类型,由于上颈椎特殊的解剖结构,寰椎骨折通常为不稳定性骨折。以往的寰椎骨折治疗方法中,外固定往往带来低骨愈合率和远期颈痛,而颈枕融合与寰枢椎融合则牺牲了颈椎活动度。近年来,有学者经口咽入路到达寰椎前方,通过前路寰椎侧块螺钉及配套钢板同时完成骨折块的复位及固定,随访证明此术式保证骨性融合的同时最大程度地保留了颈椎活动度,还具有出血少、不剥离后路组织等优点,但存在术中脊髓与椎动脉的损伤及术后较高感染率等并发症,且对于其固定强度及手术的适应范围方面仍有待进一步研究证明。总之,经口咽入路单节段固定是治疗寰椎骨折的有效方法,给脊柱外科医师提供了新的思路。

Research progress on reatment of unstable atlas fracture with single-segment fixation by transoral approach

As a common type of fracture in cervical, atlas fracture is frequently unstable due to its special anatomical structure.In a previous treatment, external fixation was likely to bring low bony union rate and long-term neck pain, while occipito-cervical fusion and atlantoaxial fusion sacrifice range of motion in cervical spine.Reduction and single section fixation of atlas by anterior lateral mass screws through the transoral approach were reported by some scholars, and the retrospective study demonstrated the high healing rate, reservation of cervical ROM and less bleeding.But it also has high risks of cervical spinal cord and vertebral artery damage, as well as the post-operation infection.Moreover, the indication and fixation strength require further evidences.As a result, this surgical option provides a new way for spinal surgeons to deal with unstable atlas fractures.