C2-C3前路颈椎间盘切除：解剖学考量与结局。

文献信息

中文摘要

引言： 由于复杂的神经血管解剖和有限的手术入路，C2-C3的前路颈椎间盘切除与融合术（ACDF）在技术上要求很高。针对该入路的全面解剖学指导仍然有限。我们提供了C2-C3前路入路的详细解剖学综述，并展示了本机构在多种适应证下实施该手术的临床结局。
材料与方法： 将全面的文献综述与手术经验相结合，以描述C2-C3 ACDF的相关解剖和技术考量。在这项回顾性系列中，分析了在本机构接受ACDF（包括C2-C3）的患者的人口统计学资料、手术细节、并发症和结局。
结果： 2022年至2025年间，有8例患者（75%为女性，平均年龄：60.6岁）接受了包括C2-C3在内的ACDF。适应证包括近端交界性失败、创伤、感染、类风湿关节炎和退变性脊髓病。融合范围从单节段C2-C3到多节段C2-C7重建。平均手术时间为78.9分钟，平均失血量为21.9毫升。37.5%的患者出现并发症，包括持续性吞咽困难（n=2）和拔管失败（n=1）。未发生直接的神经血管损伤。平均住院时间为16.4天。
结论： C2-C3的ACDF需要掌握解剖学，包括体位、序贯分离和神经血管结构的识别。对解剖学原则的仔细关注使该手术能够安全实施，而不产生特定的神经血管损伤，尽管吞咽困难和气道相关并发症仍然是常见的并发症。这项工作为应对这一具有挑战性的节段提供了实用策略。

英文摘要

INTRODUCTION: Anterior cervical discectomy and fusion (ACDF) at C2-C3 is technically demanding due to complex neurovascular anatomy and limited surgical access. Comprehensive anatomical guidance for this approach remains limited. We provide a detailed anatomical review of the anterior approach to C2-C3 and present institutional clinical outcomes for this procedure across a range of indications.
MATERIALS AND METHODS: A comprehensive literature review was synthesized with surgical experience to describe relevant anatomy and technical considerations for C2-C3 ACDF. In this retrospective series, patient demographics, operative details, complications, and outcomes were analyzed for patients undergoing ACDF, including C2-C3 at our institution.
RESULTS: Eight patients (75% female, mean age: 60.6) underwent ACDF, including C2-C3 between 2022 and 2025. Indications included proximal junctional failure, trauma, infection, rheumatoid arthritis, and degenerative myelopathy. Fusions ranged from single-level C2-C3 to multilevel C2--C7 constructs. Mean operative time was 78.9 min with mean blood loss of 21.9 cc. Complications occurred in 37.5% of patients, including persistent dysphagia (n = 2) and failed extubation (n = 1). No direct neurovascular injuries occurred. Mean length of stay was 16.4 days.
CONCLUSIONS: ACDF at C2-C3 requires mastery of anatomy, including positioning, sequential dissection, and identification of neurovascular structures. Careful attention to anatomical principles allows this procedure to be performed safely without producing specific neurovascular injury, although dysphagia and airway-related morbidity remain common complications. This work provides practical strategies for navigating this challenging level.