Rathod Ashok Keshav, Dhake Rakesh Padmakar, Muttha Mohit Navinchand, Singh Amit Indrasan, Thakur Dattatray Vilas
Department of Orthopaedics, LTMMC and LTMGH, Mumbai, Maharashtra, India.
J Craniovertebr Junction Spine. 2018 Apr-Jun;9(2):96-100. doi: 10.4103/jcvjs.JCVJS_153_17.
OBJECTIVE/PURPOSE: The objective of this study is to describe our experience with the use of stay sutures and transverse neck incision for anterior cervical spine surgeries involving multiple levels.
Transverse incisions on neck usually heal with minimal fibrosis resulting in cosmetically acceptable scars whereas vertical incision, although provides greater exposure, heals with extensive fibrosis resulting in ugly scars. Transverse incision is thus highly recommended. However, the fear of nonextensibility of transverse incision for multilevel fusion has led to the preference of vertical incision, development of techniques for identifying the optimal level of the incision, or has suggested the usage of two transverse incisions.
Seventy-six patients underwent anterior cervical spine surgeries using a transverse neck incision for single or multilevel discectomy/corpectomy and fusion. Having divided the platysma, dissection was carried down to the anterior surface of the cervical spine between the carotid sheath laterally and the trachea and esophagus medially. Stay sutures were taken through the platysma and subcutaneous tissue, converting the transverse incision into a quadrilateral window providing access for as much as three-level corpectomy or five levels of fixation.
All the wounds healed with no evidence of wound-related complications, leaving a cosmetically acceptable scar.
Using appropriately placed stay sutures, a transverse neck incision taken in the middle of the field of work can provide enough of a surgical window to perform multilevel fusion surgeries. Its simplicity and cost-effectiveness make it easily implementable, addressing the underlying pathology adequately with best possible cosmetic results.
本研究的目的是描述我们在涉及多个节段的颈椎前路手术中使用定位缝线和颈部横切口的经验。
颈部横切口通常愈合时纤维化程度最小，形成美观上可接受的瘢痕，而垂直切口虽然提供更大的暴露范围，但愈合时纤维化广泛，导致瘢痕难看。因此强烈推荐使用横切口。然而，由于担心横切口对于多节段融合手术的扩展性不足，导致人们更倾向于使用垂直切口、开发确定最佳切口水平的技术，或者建议使用两个横切口。
76例患者接受了颈椎前路手术，采用颈部横切口进行单节段或多节段椎间盘切除术/椎体次全切除术及融合术。切开颈阔肌后，在外侧颈动脉鞘与内侧气管和食管之间向下解剖至颈椎前表面。通过颈阔肌和皮下组织放置定位缝线，将横切口转变为四边形窗口，可为多达三个节段的椎体次全切除术或五个节段的固定提供操作空间。
所有伤口均愈合，无伤口相关并发症的迹象，留下美观上可接受的瘢痕。
通过适当放置定位缝线，在手术区域中部采用颈部横切口可提供足够的手术窗口以进行多节段融合手术。其操作简单且具有成本效益，易于实施，能充分解决潜在病变并获得最佳的美容效果。
