前路传统手术与腔镜辅助下小切口手术治疗胸腰段脊椎爆裂骨折

The traditional anterior surgery versus thoracoscope-assisted minimal incision surgery for thoracolumbar burst fracture

目的:比较传统前路手术与腔镜辅助下小切口前路手术治疗胸腰段脊椎爆裂骨折的早期临床效果。方法:2005年1月～2008年12月共对62例胸腰段脊椎爆裂骨折患者实施了前路手术,其中传统前路手术35例,男19例,女16例,平均年龄42岁,骨折节段:T112例,T1212例,L118例,L23例,平均后凸角19.5°,33例伴不完全性截瘫;腔镜辅助下小切口前路手术27例,男15例,女12例,平均年龄39岁,骨折节段:T112例,T129例,L114例,L22例,平均后凸角18.8°,26例伴有不完全性瘫痪。随访两组患者的早期治疗效果。结果:均顺利完成手术,无血管损伤及脊髓损伤加重病例。传统手术组平均手术时间190min,平均出血量1000ml,术后2d内平均引流量450ml/d;腔镜小切口组平均手术时间230min,平均出血量600ml,术后2d内平均引流量275ml/d,二组比较有显著性差异(P<0.05)。传统手术组后凸角平均纠正至5.2°,腔镜小切口组平均矫正至5.9°,二组无显著性差异(P>0.05)。传统手术组有5例患者出现动力性肠梗阻,9例腹壁皮神经损伤,3例肺不张,1例切口愈合不良;腔镜小切口组出现2例动力性肠梗阻,3例腹壁皮神经损伤,1例肺不张,经对症处理后均痊愈。随访8～24个月,平均16.5个月,两组患者均获得良好骨性融合,无内固定失败和矫正度明显丢失。59例不完全截瘫患者神经功能均获得1级以上改善。结论:采用传统前路手术和腔镜辅助下小切口前路手术治疗胸腰段脊椎爆裂骨折均能取得良好的早期疗效,但腔镜辅助下小切口前路手术损伤较小,并发症较少。

Objective：To compare the clinical efficacy of the traditional anterior surgical method and the thoracoscope-assisted minimal incision surgery for thorocolumbar burst fracture.Method：62 patients with thoro- columbar burst fracture were treated either by traditional anterior surgery,or by thoracoscope -assisted minimal incision anterior surgery between January 2005 and December 2008.There were 35 patients in traditional group,with 19 males and 15 females,the average age was 42 years,the segements were involved as follows, Tll in 2 cases,T12 in 12 eases,Ll in 18 cases,L2 in 3 cases,and the average kyphotie angle was 19.5°. 33 cases suffered incomplete paraplegia.There were 27 patients in thoracoscope-assisted minimal group,with 15 males and 12 females,the average age was 39 years,the involved segements were Tll in 2 cases,T12 in 9 cases,L1 in 14 cases,L2 in 2 cases,and the average kyphotic angle was 18.8°,23 cases suffered incom- plete paraplegia.The early therapeutic efficacy of all patients in both groups was observed by follow-up.Re- suit：All operations were successful,no complication related to blood vessels or spinal injury occurred.In tradi- tional group,the average operation time was 190rain,the mean blood loss was 1000ml,tbe mean drainage vol- ume within the first two days was 450ml,while in thoracoscope-assisted minimal incision group,operation time was 230min,the blood loss was 600ml,the drainage volume within the first two days was 275ml.There were significant difference in these data between the two groups（P〈0.05）,but no difference in the correction rate of kyphotic angle （P〉0.05） as mean correction angle of the kyphosis was 18.1° by traditional method,18.5° by the minimal incision group.The fellow-up time was 16.5 months （range,from 8-24 months ） .There was no failure of internal fixation and no loss of corrective kyphotic angle in two groups,all patients had successfully bony fusion.Postoperative neurological ruction was improved at least [ degree for all incomplete paraplegia patients.In traditional group,the complications included 5 cases with dynamic ileus,9 eases with iliohypogastrie and ilioinguinal nerve injury,3 cases with pulmonary ateleetasis,and 1 ease with wound healing problem. There were 2 cases with dynamic ileus,3 eases with iliohypogastric and ilioinguinal nerve injury, 1 ease with pulmonary in thoraeoseope-assisted minimal group.All above complications were cured by symptomatic treat- ment .Conclusion ： Both traditional anterior surgery and thoraseope -assisted minimal incision surgery for thoraeolumbar burst fracture may obtain a satisfactory outcome at early clinical stage,but the thoraeo-seope- assisted minimal incision surgery can provide less complication and tissue invasion.