胸腔镜辅助下前路减压植骨融合术治疗合并椎间盘损伤的下胸椎椎体爆裂骨折

Anterior decompression and autograft fusion under video-assisted thoraco-scopic to treat lower thoracic vertebrae bursting fracture complicated with intervertebral disc injury

目的观察胸腔镜辅助下前路减压植骨融合术治疗合并椎间盘损伤的下胸椎椎体爆裂骨折的疗效。方法2005年12月至2008年5月，应用胸腔镜辅助下前路减压植骨融合术治疗合并椎间盘损伤的下胸椎椎体爆裂骨折患者共11例。男10例，女1例；年龄17-56岁，平均34岁；T125例，T114例，T-0及R各1例。骨折按AO分型：A2．2型4例，A3型7例。脊髓神经功能按Frankel分级：A级5例，C级2例，D级2例，E级2例。术后第1年随访3次，分别是3、6和12个月，其后每12个月随访一次。随访项目包括症状、体征、X线或CT检查以及Frankel评分。结果所有患者手术均顺利完成，手术时间3．5-8h，平均（5．2＋1．6）h，术中出血量600-3800ml，平均（1195±576）ml。术后1例患者出现肋间神经痛，经对症处理后消失。所有患者均得到随访，随访时间36-65个月，平均（49．5±5．9）个月。24个月随访时摄CT片均证实植骨已获得骨性融合。随访期内无其他并发症发生。末次随访时，Frankel分级：A级5例，D级2例，E级4例。结论胸腔镜辅助下前路减压植骨融合术是治疗合并椎间盘损伤的下胸椎椎体爆裂骨折的有效方法，但该方法技术要求高，具有较长的学习曲线。

Objective To study the effect of anterior decompression and autograft fusion under video-assisted thoracoscopic to treat lower thoracic vertebrae bursting fracture complicated with intervertebral disc injury. Methods Eleven patients who suffered from lower thoracic vertebrae bursting fracture complicated with intervertebral disc injury were treated with anterior decompression and autograft fusion under video-assisted thoracoscopic from December 2005 to May 2008. The involved vertebrae included T12 in 5 cases, Tn in 4 cases, T10 in 1 ease and T8 in 1 case. According to the AO classification, 4 patients were A2.2 and 7 were A3. According to the Frankel classification, 5 patients were rated as grade A, 2 as grade C, 2 as grade D and 2 as grade E. Results Every patient underwent successful operation. The operation time was 3.5-8 h（average, 5.2±1.6）. The blood loss was 600-3800 ml（average, 1195±576）. One patient got intercostal neuralgia after operation, which disappeared after treating with analgesic drugs for 7 days. All patients were followed up for 36-65 months （average, 49.5±5.9）. All patients got bony fusion according to the CT scans 24 month after operation. There were no neurological function deterioration and other instrument complications happened. At the last follow-up, 5 patients were rated as grade A, 2 as grade D and 4 as grade E, according to the Frankel classification. Conclusion Anterior decompression and autograft fusion under video-assisted thoracoscopic is an effective method to treat lower thoracic vertebrae bursting fracture complicated with intervertebral disc injury. However, this method needs higher technology and has a long study-curve.