前方经咽后入路切口治疗上颈椎病变

目的探讨颈椎前方经咽后入路切口治疗上颈椎病变的临床疗效。方法 9例上颈椎病变患者,均采用前方经咽后入路切口实施颈椎前路手术,其中包括前后路手术1例,术前JOA评分平均（8.6±1.2）分,枢椎椎弓骨折2例,颈椎肿瘤3例,颈椎结核1例,颈椎间盘突出2例,颈椎畸形1例。结果 9例患者术中均清楚显露C1~C3椎体前方,完成减压复位、病灶清除、融合内固定等操作;有脊髓压迫者术后脊髓神经功能得到一定程度的改善。全部伤口于2周后获甲级愈合,无伤口感染病例。1例术后出现口轮匝肌瘫痪,1周左右自行缓解,1例出现术后呛咳,3周左右自行缓解,其余病例未出现颈部重要神经血管损伤与相应节段的颈髓损伤。9例患者均经平均12（10~16）个月随访,JOA评分术后平均（13.4±1.6）分,与术前比较有显著差异（P〈0.01）。结论经高位前方咽后入路可充分显露上颈椎前方,进行直接有效的手术操作,创伤小,并发症少,是理想的显露途径。

Anterior Retropharyngeal Approach for the Treatment of Upper Cervical Diseases

Objective To investigate the exposure of the upper cervical operations from the high anterior cervical retropharyngeal approach.Methods 9 patients of the upper cervical diseases were operated through the anterior cervical retropharyngeal approach in which 1 case combined with posterior approach.The preoperative JOA score was 8.6±1.2 in average.The upper cervical diseases included Hangman＇s fracture of 2,tumor of 3,tuberculosis of 1,disc herniation of 2,deformation of 1.Results All the patients＇ surgical field was clearly revealed in front of C1 to C3 vertebra to accomplish the decompression and reduction,debridement,fusion and internal fixation and other operations.Spinal cord oppressors achieved a certain degree of improvement,and the postoperative JOA score was 13.4±1.6 in average,which was much better than the preoperative one（P0.01）.1 case developed paralysis of the orbicularis oris muscle and was relieved a week later.1 case developed postoperative cough,and relieved itself 3 weeks later.No other complication such as wound infection,major nerves and blood vessels injury,or spinal cord injury was found.Conclusion The high anterior cervical retropharyngeal approach to the upper cervical spine is a favorable approach with less trauma,fewer complication,and clearer operative field reveal.