胸腔镜辅助下小切口在胸椎前路手术的临床应用

Thoracoscopic minimal access anterior surgery for thoracic spine

目的 探讨胸腔镜辅助下小切口行胸椎前路手术的可行性。 方法 2 0 0 1年 10月～ 2 0 0 2年 10月 ,我院在胸腔镜辅助下小切口行胸椎前路手术 14例。其中 6例胸椎转移瘤行病变椎体切除、钢板骨水泥椎体重建及前路针棒内固定 ;4例胸椎结核行病灶清除、植骨及前路钉棒内固定 ;2例胸椎间盘突出症行髓核摘除、椎间植骨融合 ;2例胸椎椎体骨折合并脱位行脱位椎体复位、椎管减压、椎体间植骨及前路钉棒内固定。 结果 术后影像学显示病灶清除彻底 ,内固定效果确切。 14例术后随访 4～ 12个月 ,14例胸背痛完全消失 ,13例脊髓压迫症中除 1例转移瘤无改善外 ,其余 12例肌力术前A～D级 ,术后恢复至C～E级。 结论 胸腔镜辅助下小切口行胸椎前路手术方法可行 。

Objective To investigate the feasibility of thoracoscopic minimal access anterior surgery for thoracic spine. Methods Minimal access anterior thoracic surgery was conducted under thoracoscope in 14 patients in this hospital from October 2001 to October 2002.Six patients with thoracic vertebral metastasis underwent vertebral body excision, reconstruction by cement and steel plate, and anterior internal fixation with screw-rod system;4 patients with thoracic vertebral tuberculosis received focus resection,bone graft and anterior internal fixation with screw-rod system; 2 patients with of thoracic disc herniation received discectomy and fusion;2 patients with thoracic vertebral facture and dislocation received reduction, decompression, bone graft and anterior screw-rod internal fixation. Results Postoperative imageological analysis revealed that the focus had been cleaned completely and the internal fixation was excellent. Follow-up for 4～12 months in 14 patients showed that the pain on chest and back disappeared in all the patients. Of the 13 patients with spinal compression, muscle strength recovered from grade A～D preoperatively to grade C～E postoperatively. Conclusions Thoracoscopic minimal access anterior thoracic surgery is feasible. It offers satisfactory short-term effects.