有限切口在胸腰段骨折前路手术治疗的应用

Anterior approach operation of thoracolumbar fractures through limited incision

[目的]讨论胸腰段骨折前路手术中采用有限切口的方法和疗效。[方法]对34例严重的胸腰段骨折的患者不是常规采用高于伤椎二位肋骨的胸腹联合切口，而采用左侧经胸膜后，腹膜后入路椎管前方减压去除位于后纵韧带前方的致压骨折块及破裂后突的椎间盘组织。术前通过X线平片、CT和／或MRI扫描来确定骨折的类型、脊髓受压情况等，确认导致脊髓神经压迫或损伤的致压物来自硬膜囊前方的椎体碎骨折块及破裂的椎间盘组织，作为选择治疗方式的重要参考因素。[结果]采用此技术，治疗胸腰段骨折34例，均无术中并发症，出血量300—800ml，平均600ml，手术时间120—150min。术后随访6—24个月。术后无脊髓再损伤病例，伤椎部位脊椎曲度恢复正常，无明显侧凸或后凸畸形发生；术后3个月复查植骨愈合良好，无植骨块塌陷及高度丢失现象，随访期内无植骨不愈合或钢板螺钉断裂现象。[结论]有限的胸腰段骨折前路入路操作技术，可减少对患者肺功能的严重影响，减轻前路手术创伤，为患者顺利恢复创造条件。

[ Objective] To investigate the surgical method and clinical effects of the anterior approach operation in the treatment of thoraco - lumbar vertebral fractures through limited incision. [ Method] Thirty - four eases of bursting fracture of thoracolumbar vertebral body were treated with the operation of anterior decompression, bone grafting and internal fixation by the anterior retropleuro - peritoneum approach. The MRI combined with clinical examination, X - ray, CT results were taken as selection criteria of treatment. [ Result] Thirty - four cases were treated with this operative technich. Hemorrhage capacity is about 300 - 800ml with average 600ml. The operation time was 2 -2.5 hours. All patients were followed - up with an average period of 18 months（ ranged, 6 -24months）. No aggravation of nerve injury appeared in 34 cases. X -ray manifested good fusion , no bro- ken nails and no recurrence of kyphosis was found in all cases. [ Conclusion ] Anterior approach operation through limited incision is an effective way for severe thoracolumbar fractures. It has significantly low complication and allow early recovery of function.