【摘要】 目的评价内窥镜辅助下经颈前入路上颈椎重建技术治疗上颈椎疾病的临床疗效。方法回顾性分析2005年1月～2007年12月内窥镜辅助下经颈前路手术治疗的6例上颈椎疾病患者,其中3例为固定性寰枢关节脱位,3例为C2椎体肿瘤。均采用内窥镜辅助下颈前入路C2椎体切除、脊髓减压、自体髂骨重建和后路内固定融合术。评价内容包括:颈痛疼痛视觉模拟量表(visual analogue scale,VAS)评分、神经系统功能、并发症、植骨融合情况,对肿瘤患者复发或转移亦进行评估,并行统计学分析。结果所有患者随访24～47个月,平均34个月。固定性寰枢关节脱位患者平均VAS评分由术前3.7分减少到1.2分(P<0.01);肿瘤患者平均VAS评分由术前6.2分减少到1.3分(P<0.01)。所有患者术后神经功能均得到改善。1例寰枢关节脱位患者术后第1天出现脑脊液漏,通过卧床休息,术后7 d脑脊液漏自发闭合。所有患者未发生术后伤口感染并发症。末次随访时无内固定松动、断裂,所有患者均获得骨性融合,亦无肿瘤复发或转移病例。结论内窥镜辅助下颈前路C2椎体切除、自体髂骨重建联合后路内固定融合术治疗上颈椎疾病可以获得满意的临床疗效。更多还原

【Abstract】 Objective To assess the clinical efficacy of endoscopic-assisted anterior transcervical reconstruction for treatment of ventral lesions in the upper cervical spine.Methods Six patients with upper cervical spine disease,who underwent endoscopic-assisted anterior reconstruction during January 2005 to December 2007,were retrospectively analyzed.Three patients had fixed atlantoaxial dislocations and the other 3 had C2 primary tumors.All the patients were treated by a combination of endoscopic-assisted anterior odontoidectomy,cord decompression,reconstruction using autologous iliac bone,and posterior internal fixation and interbody fusion.The evaluation parameters included(visual analogue scale,VAS)scores of neck pain,neurological function,complication,bony fusion,and tumor recurrence or metastasis.Statistical analysis was performed.Results All the cases were followed up for 24-47 months(a mean of 34 months).The 3 patients with fixed antlantoaxial dislocation had VAS decreased from 3.7 to 1.2(P<0.01)after operation,and the 3 patients with tumors had VAS decreased from 6.2 to 1.3(P<0.01).Neurological functions were improved in all patients.One patient with fixed atlantoaxial dislocation developed cerebrospinal fluid leak 1 day after operation,which was spontaneously resolved 7 d after surgery.There was no incision infection or fixation failure;bony fusion was achieved in all cases;no tumor recurrence or metastasis was found.Conclusion Endoscopic-assisted anterior transcervical odontoidectomy,cord decompression,and reconstruction using autologous iliac bone combined with a posterior arthodesis can achieve satisfactory clinical outcomes in patients with ventral lesions in the upper cervical spine.更多还原