经肾小管经口入路治疗不可复位的腹侧颅颈交界区压迫性病变：手术技术与结果
Transtubular Transoral Approach for Irreducible Ventral Craniovertebral Junction Compressive Pathologies: Surgical Technique and Outcome.
作者信息
Ariffin M H, Mohd-Mahdi S N, Baharudin A, M Tamil A, Abdul-Rhani S, Ibrahim K, Ng B W, Tan J A
机构信息
Department of Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Department of Anaesthesiology and Intensive Care, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
出版信息
Malays Orthop J. 2023 Jul;17(2):35-42. doi: 10.5704/MOJ.2307.006.
INTRODUCTION
To investigate the use of a tubular retractor to provide access to the craniovertebral junction (CVJ) sparing the soft palate with the aim of reducing complications associated with traditional transoral approach but yet allowing adequate decompression of the CVJ.
MATERIALS AND METHODS
Twelve consecutive patients with severe myelopathy (JOA-score less than 11) from ventral CVJ compression were operated between 2014-2020 using a tubular retractor assisted transoral decompression.
RESULTS
All patients improved neurologically statistically (p=0.02). There were no posterior pharynx wound infections or rhinolalia. There was one case with incomplete removal of the lateral wall of odontoid and one incidental durotomy.
CONCLUSIONS
A Tubular retractor provides adequate access for decompression of the ventral compression of CVJ. As the tubular retractor pushed away the uvula, soft palate and pillars of the tonsils as it docked on the posterior pharyngeal wall, the traditional complications associated with traditional transoral procedures is completely avoided.
引言
研究使用管状牵开器进入颅颈交界区（CVJ），同时避开软腭，目的是减少与传统经口入路相关的并发症，同时实现CVJ的充分减压。
材料与方法
2014年至2020年间，对12例因腹侧CVJ压迫导致严重脊髓病（日本骨科协会评分低于11分）的连续患者，采用管状牵开器辅助经口减压手术。
结果
所有患者神经功能均有统计学意义的改善（p = 0.02）。无咽后伤口感染或鼻音。有1例齿状突侧壁切除不完全，1例意外硬脊膜切开。
结论
管状牵开器为CVJ腹侧压迫的减压提供了足够的入路。由于管状牵开器对接在咽后壁时推开了悬雍垂、软腭和扁桃体柱，完全避免了与传统经口手术相关的传统并发症。
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