肩胛下高位经胸腔入路治疗上胸椎病变的疗效观察  

The High Transthoracic Approach to Treat Disorders of the Lesion of Upper Thoracic Spine

作　　者：刘柱同[1] 矢庆明[2] 殷明[2] 顾玉荣[2] 吴庆[2] 

机构地区：[1]武警广东省总队医院骨科,广州510507 [2]南昌大学第二附属医院骨科,南昌330006

出　　处：《江西医学院学报》2007年第2期29-32,共4页Acta Academiae Medicinae Jiangxi

摘　　要：目的探讨肩胛下高位经胸腔入路行上胸椎前方减压内固定的显露效果。方法本组3例患者,其中结核2例,骨折1例。所有患者均采用肩胛下高位经胸腔入路,结核行病灶清除、植骨内固定;骨折行侧前方减压、植骨内固定。结果3例病人均成功的显露出胸3-5椎体;2例结核患者病灶清除彻底,术后结核中毒症状明显好转,1例爆裂性骨折病人行椎体次全切、侧前方减压,植骨内固定,恢复了脊柱的稳定性和正常序列,无1例出现纵膈内神经,大血管及胸导管损伤和脑脊液漏等并发症。随访6个月,2例结核患者脊髓功能均有不同程度恢复。结论肩胛下高位经胸腔入路手术视野开阔,病变节段显露清楚,病灶清除彻底,椎体序列恢复好,并发症少,是处理上胸椎病变的较理想入路。Objective To evaluate the exposure of the high transthoracic approach for anterior decompression and instrumentation at the upper thoracic vertebrae. Methods There were three patients, two tuberculosis and one fracture of upper thoracic vertebrae. All patients were operated on throngh high transthoracic approach. Tuberculosis was treated through lesion clearance, bone graft and internal fixation; Anterior decompression and bone graft, fixation was undergone for vertebrae fracture. Results Successful exposure lesion were made in all patients. Toxic symptom of tuberculosis after lesion clearance were improved obviously in two tuberculosis patients; Stability and sequence of spine were reconstructed after vertebrectomy, anterior decompression and fusion in vertebrae blowout fracture patient. There were no serious complication as results of injuries of nerves, vessels or thoracic duct in mediastina and leakage of cerebrospinal fluid. In follow-up period of six months, the neurological function in two tuberculosis patients were improved. Conclusion Process of upper spine was exposed very clearly and the operation field was widened with this approach, enough resection was available and spine sequence was improved with few complications. It may be an ideal approach to treat disorders of the lesion of upper thoracic spine.

关 键 词：肩胛下高位经胸腔入路 上胸椎 治疗 

分 类 号：R655.1[医药卫生—外科学]