经口咽下颌骨劈开入路处理上颈椎或上、下颈椎腹侧病变  

The treatment of the spinal cord ventral lesions involving upper and lower cervical spine by a transoral- translabiomandibular approach

作　　者：尹庆水[1] 夏虹[1] 权日[1] 昌耘冰[1] 刘晖[1] 何帆[1] 艾福志[1] 汪维健[1] 

机构地区：[1]广州军区广州总医院骨科,广州市510010

出　　处：《中国脊柱脊髓杂志》2008年第1期41-44,共4页Chinese Journal of Spine and Spinal Cord

基　　金：广东省自然科学基金团队项目(编号:20023001)

摘　　要：目的:探讨经口咽下颌骨劈开入路处理上颈椎或上、下颈椎腹侧病变的临床效果。方法:采用经口咽唇面下颌骨劈开入路处理伴有下颌关节僵直的陈旧性寰枢椎脱位1例,行TARP钢板内固定术;处理枢椎体肿瘤1例,行C2椎体肿瘤切除,异形钛网笼置入重建椎体,同期行后路C1￣C3椎弓根钉棒植骨内固定术。采用经口、舌、唇面下颌骨劈开入路处理C1￣C5肿瘤1例,行肿瘤切除,异形钛网笼置入重建C2￣C4椎体,同期后路C1￣C5附件肿瘤切除,枕颈植骨融合内固定术。随访观察治疗效果。结果:病变部位显露满意,顺利完成手术操作。随访12￣24个月,2例肿瘤患者的肿瘤切除彻底,前路椎体重建满意,后路内固定稳妥,临床症状消失,行走正常;1例寰枢椎陈旧性脱位患者的寰枢椎达解剖复位,颈髓减压充分,C1￣C2前路内固定稳妥,临床症状消失。结论:经口咽下颌骨劈开扩大入路适合于处理同时累及上下颈椎的腹侧病变或患者张口困难的上颈椎腹侧病变。Objective：To study the clinical effect of the treatment of the spinal cord ventral lesions involving upper and lower cervical spine by a transoral-translabiomandibular approach.Method：One case of old atlantoaxial dislocation with the stiffness of temporomandibular joint was treated with TARP internal fixation by the above mentioned approach.Another case of C2 tumor was treated with tumor resection,vertebral reconstruction by a special shaped titanium mesh system,posterior C1-C3 internal fixation by a transpedicle screwrod system and autogenous bone graft at one stage.The third case of C1-C5 tumor was treated with one-stage combined anterior-posterior tumor resection including C2-C4 vertebrae body and C1-C5 appendix,C2-C4 vertebral reconstruction by the special shaped Titanium Mesh System,and posterior occipitocervical internal fixation and autogenous bone graft.Result：This kind of surgery had a good surgical field exposure.At a follow-up of 12-24 months,two patients with tumor had complete tumor resection,satisfactory anterior reconstruction,and stable posterior internal fixation.Their clinical symptoms disappeared and both of them walked normally.The patient with old adantoaxial dislocation obtained atlantoaxial anatomical reduction,thorough cervical cord decompression and stable internal fixation.His neurological symptom relieved completely.Conclusion：Transoral- translabiomandibular approach is suitable for the treatment of the ventral lesions involving upper and lower cervical spine or complicated with stiffness of temporomandibular joint.

关 键 词：经口咽下颌骨劈开入路 上颈椎 下颈椎 

分 类 号：R687.3[医药卫生—骨科学] R738.1[医药卫生—外科学]