Castein Jens, Hoffmann Christoph-Heinrich, Kandziora Frank
Center for Spinal Surgery and Neurotraumatology, BG Hospital, Frankfurt am Main.
Z Orthop Unfall. 2019 Feb;157(1):82-93. doi: 10.1055/a-0621-9430. Epub 2018 Jul 3.
Even though in recent years the number of transoral spinal interventions has decreased in Europe and North America - mainly because of the progress in the drug therapy of rheumatism, there are still pathologies that can only be addressed by a transoral approach. The classical transoral approach can be expanded in collaboration with oral-maxillofacial surgery and ear, nose and throat surgery, but this is rarely necessary. The transoral approach is now mainly used for resection of pathological tissue. Additional stabilisation is often necessary and is performed in Europe and North America via a posterior approach, due to the lack of availability of anterior plate systems. Anterior plate systems are still used in India and China. In these countries, the numbers of transoral operations are generally still increasing. Today the indications for transoral spinal surgery consist mainly of infections and tumours, and more rarely of trauma and congenital malformations of the craniocervical junction. The numbers of surgical interventions for these indications has remained constant in recent years. The most recent advancement is the use of endoscopes and transnasal access. With these techniques, additional alternatives and supplements are available for further reducing the morbidity of transoral surgery. Despite the low number of cases, surgical therapy of the corresponding pathologies can be offered to patients with a calculable risk.
尽管近年来欧洲和北美的经口脊柱干预手术数量有所减少——主要是因为风湿病药物治疗取得进展，但仍有一些病症只能通过经口手术来解决。经典的经口手术方法可以与口腔颌面外科以及耳鼻喉科合作进行扩展，但这种情况很少有必要。经口手术方法目前主要用于切除病变组织。由于缺少前路钢板系统，在欧洲和北美通常需要额外的稳定措施，通过后路手术来实施。前路钢板系统在印度和中国仍在使用。在这些国家，经口手术的数量总体上仍在增加。如今经口脊柱手术的适应症主要包括感染和肿瘤，很少用于创伤以及颅颈交界区的先天性畸形。近年来针对这些适应症的手术干预数量保持稳定。最新的进展是使用内窥镜和经鼻入路。有了这些技术，可以有更多的选择和补充手段来进一步降低经口手术的发病率。尽管病例数量较少，但对于有可计算风险的患者，仍可提供相应病症的手术治疗。
