经骶棘肌腰方肌间隙行胸腰段脊柱脊髓损伤侧前方减压术

The anterolateral decompression to thoracolumbar spinal cord injury between erector spine muscles and quadratus lumborum muscles

目的：寻求胸腰段脊柱脊髓损伤侧前方减压的新入路。方法：利用胸腰段的解剖关系设计经骶棘肌腰方肌间隙入路行胸腰段脊柱侧前方减压术。结果：临床应用１２例，手术时间１～１．５ｈ，从皮肤切口到完全显露椎体出血４０～６０ｍｌ。此入路不切断骶棘肌、腰方肌、腰大肌及膈肌，不会伤及胸膜等。随访３～６个月，基本痊愈４例，显著进步３例，进步５例。结论：经骶棘肌腰方肌间隙行胸腰段脊柱侧前前方减压入路简捷，损伤小，出血少。既能充分减压，又能最大限度保持脊柱的稳定性，还可避免加重脊髓损伤、胸膜损伤等并发症。

Objective:To explore a new way of anterolateral decompression(ALD) into thoracolumbar spinal cord injury.Method:ALD was performed in 12 patients through the space between erector spine muscles and quadratus lumborum muscles according to the anatomic relation of the thoracolumbar spine.Result:The satisfactory results was achieved in 12 cases.The time of the operation taked 1￣1 5h,the loss of blood were 40￣60ml during the surgical approach.Muscles around spine were not cut.No injury of pleura was found.The results of 4 cases were excellent,3 cases were good,5 cases were fair with of 3￣6 mouths of follow up.Conclusion:The present operation is better than simple entrance.There are less injury,less bleed,optimal combination of the effective decompression and the best maintenace of the spinal stability,and less complications such as the spinal cord and pleura injury caused by dragging in the operation. Authors address\ Department of Orthopaedics,Affiliated Hospital,Zunyi Medical College,Zunyi,Guizhou,563003