微创改良 Goel-Harms 寰枢椎融合技术：病例系列和说明性指南。

Minimally invasive modification of the Goel-Harms atlantoaxial fusion technique: a case series and illustrative guide.

出版信息

Neurosurg Focus. 2023 Mar;54(3):E14. doi: 10.3171/2022.12.FOCUS22635.

DOI:10.3171/2022.12.FOCUS22635

Abstract

OBJECTIVE

The Goel-Harms atlantoaxial screw fixation technique for the treatment of atlantoaxial instability and unstable odontoid fractures is reliable and reproducible for a variety of anatomies. The drawbacks of the technique are the potential for significant bleeding from the C2 nerve root venous plexus and the risks associated with posterior midline exposure and retraction, such as pain and wound complications. The authors developed a minimally invasive surgical (MIS) modification of the Goel-Harms technique using intra-articular grafting to facilitate placement of percutaneous lateral mass and pars screws with extended tabs for minimally invasive subfascial rod placement. The objective of this study was to present the authors' first series of 5 patients undergoing minimally invasive modification in comparison with 51 patients undergoing open atlantoaxial fusion.

METHODS

A retrospectiveanalysis of patient comorbid conditions, blood loss, length of surgery, and length of stay was performed on patients undergoing Goel-Harms instrumented fusion (GHIF) for unstable odontoid fractures performed between 2016 and 2021.

RESULTS

Patients undergoing the minimally invasive procedure showed significantly less blood loss than those undergoing the open atlantoaxial fusion procedure, with a median blood loss of 30 ml compared with 150 ml using the open technique (p < 0.01). The patients showed no significant differences in length of stay (2 days for MIS vs 4 days for open atlantoaxial fusion, p = 0.25). There were no significant differences in length of surgery for MIS, but a possible trend toward increased operative duration (234 vs 151 minutes, p = 0.112).

CONCLUSIONS

In this small pilot study, it was shown that MIS-GHIF can be performed with decreased blood loss in atlantoaxial instability and odontoid fractures. This technique may allow for greater and safer application of the procedure in the elderly and infirm.

摘要

目的

Goel-Harms 寰枢螺钉固定技术治疗寰枢椎不稳和不稳定齿状突骨折，适用于多种解剖结构，具有可靠性和可重复性。该技术的缺点是可能会引起 C2 神经根静脉丛大量出血，以及与后路中线暴露和牵引相关的风险，如疼痛和伤口并发症。作者开发了一种 Goel-Harms 技术的微创外科（MIS）改良方法，采用关节内植骨术，便于使用带延长翼的经皮侧块和 pars 螺钉进行微创筋膜下棒放置。本研究的目的是介绍作者对 5 例接受微创改良的患者的系列研究，并与 51 例接受开放式寰枢融合术的患者进行比较。

方法

对 2016 年至 2021 年间接受 Goel-Harms 器械融合（GHIF）治疗不稳定齿状突骨折的患者的合并症、出血量、手术时间和住院时间进行回顾性分析。

结果

接受微创手术的患者出血量明显少于接受开放式寰枢融合术的患者，中位数出血量为 30ml，而开放式技术为 150ml（p<0.01）。微创组和开放组的住院时间无显著差异（分别为 2 天和 4 天，p=0.25）。微创组的手术时间无显著差异，但手术时间可能有延长的趋势（234 分钟与 151 分钟，p=0.112）。