胸椎、上腰椎爆裂骨折胸腔镜下小切口前路手术

Anterior Access Surgery with Video-Assisted Thoracoscopy in Burst Fracture of Thoracic Vertebrae and Upper Lumbar Vertebrae

目的探讨在胸腔镜辅助下小切口进行胸椎、上腰椎前路手术的可行性。方法10例T9～L1椎体爆裂型骨折并脊髓压迫症及1例陈旧性L1椎体爆裂骨折合并马尾综合征患者,行胸腔镜下脊髓减压、植骨、钢板螺丝钉内固定术。结果全部病例切口Ⅰ期愈合,X线、CT、MRI显示病灶清除彻底,脊髓充分减压,除1例骨折复位固定后仍有轻度成角畸形外,其它病例复位满意、内固定可靠,位置良好。大部分截瘫患者的临床症状不同程度好转。结论胸椎、上腰椎骨折,不论是否并发脊髓、马尾神经压迫,都适宜在胸腔镜辅助下进行脊髓减压、脊柱前路植骨、内固定手术。可选择常规气管插管、双肺通气全身麻醉下完成手术。

Objective To discuss the possibility of anterior access surgery with video-assisted thoracoscopy in burst fracture of thoracic vertebrae and upper lumbar vertebrae. Methods Ten patients with T9～L1 burst fracture and one patient with L1 old burst fracture complicated with cauda equina syndrome were treated with decompression of spinal cord, auto-iliac bonegraft and plate screw internal fixation. Results All incisions were primary healing. It was showed by examinations of X-ray,CT and MRI that there were thorough clearing of focus and sufficient decompression of spinal cord,and all cases with satisfactory reduction except one with mild angular deformity. Most patients with paraplegia showed different degrees of recovery. Conclusion Anterior access surgery with video-assisted thoracoscopy is suitable in fracture of thoracic vertebrae and upper lumbar vertebrae associated with cauda equina syndrome or compression of spinal cord. It can offer the decompression of spinal cord,the bone-graft and internal fixation. This operation can be performed under general anesthesia with endotracheal intubation and two-lung ventilation.