Objective: To study the changes of bacterial flora after a series of preoperative oral disinfection and the postoperative recovery of patients with craniovertebral junction disorders who were treated with transoral approach operations. And to provide a theoretical basis for the prevention of postoperative complications such as infection.
Methods: The clinical data of 20 cases with craniovertebral junction disorders and treated with transoral approach operations between October 2009 and May 2010 were analyzed. There were 8 males and 12 females, aged 2-66 years (median, 34.5 years). According to the classification of American Spinal Injury Association (ASIA)，there were 4 cases of grade B, 8 of grade C, 6 of grade D, and 2 of grade E. The Japanese Orthopedic Association (JOA) score was 10.3±3.0. The mucosa samples of the posterior pharyngeal wall were sent for bacteria culture. These samples were collected by sterile cotton swabs at four crucial points including 3 days before operation/before gargling (T1), 3 days after continuous gargling by chlorhexidine acetate/after anesthesia intubation on the day of operation (T2), after intraoperative cleaning and washing of the mouth (T3), and after intraoperative iodophor immersion for 5-10 minutes (T4). The microflora was stained by means of smear and further counted after an investigation by microscope. The ASIA classification and the JOA scores were applied to evaluate the postoperative nerve function of the patients. A regular reexamination of cervical vertebra with X-ray film, CT, and MRI was conducted after operation to evaluate the reduction of atlantoaxial dislocation, internal fixation position, bone graft fusion, inflammatory lesion, and tumor resection in the craniovertebral junction.
Results: After a series of oral disinfection, the mucosa of the posterior pharyngeal wall of all the patients was in a sterile state, which was considered as type Ⅰ incision. All these 20 patients were treated with successful operations, without any intraoperative injury in vertebral artery and spinal cord, or any postoperative complications such as plate loosening, incision infection, or intracranial infection. All the patients were followed up 3-23 months, with an average of 5.15 months. The symptoms such as neck pain, limb numbness and weakness, neural symptoms, etc. were improved to different degrees after operation. The JOA score was improved to 13.4±1.9 at 3 months after operation, showing significant difference when compared with preoperative score ( t=8.677, P=0.000); and the atlantoaxial joints had been fused. At last follow-up, the ASIA grades were improved when compared with those before operation.
Conclusion: It is safe and effective to cut the posterior pharyngeal muscle layer and implant internal fixation by means of transoral approach in the treatment of craniovertebral junction disorders.
目的: 研究颅脊交界区患者经口入路手术前经过一系列口腔消毒措施后其菌群组成变化情况及术后切口愈合情况，为术后感染等并发症的防治奠定理论基础。.
方法: 选择 2009 年 10 月—2010 年 5 月收治的因颅脊交界区疾患行经口入路手术患者 20 例，男 8 例，女 12 例；年龄 2～66 岁，中位年龄 34.5 岁。术前美国脊髓损伤协会（ASIA）分级为 B 级 4 例，C 级 8 例，D 级 6 例，E 级 2 例；日本骨科协会（JOA）评分为（10.3±3.0）分。于手术前 3 d/漱口前、醋酸氯己定漱口液连续漱口 3 d 后/手术当日麻醉插管后、术中清洁洗口后、术中聚维酮碘溶液浸泡消毒口腔 5～10 min 后共 4 个时间点（分别设为 T1、T2、T3、T4），用无菌棉签取咽后壁样品送细菌培养，观察菌落特征及涂片、染色，仪器行细菌种类鉴定并计数。术后采用 ASIA 分级及 JOA 评分标准评估患者神经功能改善情况。行颈椎 X 线片、CT、MRI 检查，观察颅脊交界区寰枢椎脱位复位情况、内固定物位置、植骨融合、炎性病灶或肿瘤切除情况。.
结果: 经过一系列口腔术前准备后，所有患者术中咽后壁黏膜均处于无菌状态，为Ⅰ类切口。20 例患者均成功完成手术，术中未发生椎动脉及脊髓损伤，术后无钢板松脱、切口感染或颅内感染等相关并发症发生。所有患者均获随访，随访时间 3～23 个月，平均 5.15 个月。患者术后颈部疼痛、肢体麻木乏力等症状及神经症状均有不同程度改善。术后 3 个月 JOA 评分为（13.4±1.9）分，较术前显著改善（ t=8.677， P=0.000）；寰枢椎关节均已融合。末次随访时 ASIA 分级均较术前有所改善。.
结论: 经口入路切开咽后肌肌层并植入内固定物治疗颅脊交界区疾患安全有效。.
Keywords: Craniovertebral junction; infection prevention; transoral approach.