| Background and purpose:The anatomy of the cranio-vertebral junction(CVJ)was complicated,and the surgery was difficult and high risk in this area.Recently,the quality of CVJ surgery has improved,but there are still many shortcomings and complications which could require two or more surgical revisions.What are the relevant risk factors for unscheduled reoperations and long-term revisions,and whether the internal fixation procedure performed from the oropharyngeal mucosa increases the risk of wounds?The purpose of this study:①To investigate the incidence and causes of unplanned reoperations within 30 days after the first CVJ operation,and related risk factors,and propose countermeasures;②To evaluate the advantages of TARP surgery during revision,analyze the reasons that lead to CVJ surgery failure Develop revision strategies;③To analyze the incidence of wound infection and its risk factors during TARP surgery,explore the treatment strategy of incision infection,summarize relevant experiences and lessons,and provide a reference for clinicians to reduce the complications of CVJ surgery.Materials and MethodsBased on the prospective collection of data,we retrospectively analyzed the clinical data of CVJ surgery in our department from January 2002 to December 2018.1.Screening patients who have undergone unplanned reoperation within 30 days after the initial surgery,analyze their causes and related risk factors;2.Analyze all patients who need revision,and develop revision strategies.Collect the cases undergoing TARP revision,and record the VAS score and JOA score before surgery,the last follow-up,the medullary spinal cord angle,and perioperative complications.3.Analyze the data of all TARP operations,choose the posterior surgery performed in our hospital as a case control,analyze the incidence of wound infection in the two groups,and evaluate the effect of "ladder therapy" on TARP surgery infection.Result1.A total of 2149 patients undergoing CVJ surgery were included in the study,of which 34(1.58%)required unplanned reoperation within 1 month after the initialoperation.Common causes are wound infections and implant-related factors.2.Of these 2149 cases,130 cases of the first CVJ operation were completed in other hospital,and then transferred to our hospital for requiring revision surgery.The initial and revision surgery of 45 patients were performed in our hospital.The revision rate of CVJ surgery in our hospital was 2.23%.Among the 175 cases involving revision,the main reasons for revision were improper choice of surgical method and factors related to failure of internal fixation.90 patients who underwent TARP surgery were followed up.At the last follow-up,the average JOA score and neck pain VAS score were significantly improved compared with before surgery,and the medullary spinal cord angle returned to normal.3.A total of 549 patients underwent TARP surgery.The wound infection rate was 2.9%,which was not statistically different from the infection rate of posterior surgery.The operation time>6 hours and the incision soft palate were independent risk factors.In conclusion1.The unplanned reoperation rate for CVJ surgery was 1.58%,mainly due to wound infection.2.The revision rate was 2.23%,and the common cause was an inappropriate choice of surgical method.The advantages of TARP surgery in CVJ revision are obvious,and it is particularly suitable for cases of skull base depression with posterior extensive decompression and failure of posterior internal fixation.Aiming at common causes of revision in CVJ surgery,a revision strategy was developed.3.TARP surgery would not increase the risk of wound and implant infections.Maximizing the efficiency of the surgery and avoiding the incision of the soft palate can reduce the complications of wound infections.The use of "ladder therapy" to treat wound infections after TARP can achieve better results.Cases can retain internal fixation. |
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