胸腔镜辅助下小切口在胸腰段骨折前路手术中的临床应用  

Clinical application of approach surgery by EMI-VATS in thoracolumbar vertebra fracture anterior

作　　者：熊英辉[1] 贝抗胜[1] 赵凯[2] 刘建平[1] 吴强[1] 黄水云 何小龙[1] 胡孔和[1] 卢林俊[1] 唐华军[1] 张特[1] 

机构地区：[1]广东省汕头大学医学院附属粤北医院骨科脊柱病区,512026 [2]浙江大学医学院附属邵逸夫医院骨科,杭州310016

出　　处：《中华损伤与修复杂志（电子版）》2007年第3期147-150,共4页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的探讨在胸腔镜辅助下小切口(enlarged manipulation incision of video-assisted thora- coscopic surgery,EMI-VATS)进行胸腰段椎体骨折前路手术的可行性与特点。方法2005年3月至2007年2月,应用EMI-VATS行椎管减压椎间植骨、钢板内固定治疗胸腰段爆裂型骨折9例,骨折脱位2例;平均年龄39岁;伤后1周以内施术6例,2周以内3例,3周以上2例。结果术中出血量平均为600 ml,手术时间平均为150 min,术后总引流量平均360 ml,拔除胸腔闭式引流管时间平均为55 h,发生暂时性肋间神经痛、肺不张、少量胸腔积液各1例。术后随访最长者25个月,短者43 d,术后脊柱形态均接近正常,植骨及内固定未发现移位与塌陷,对上肢功能无明显影响。神经功能恢复按Frankel分级比较,改善Ⅰ级者5例,改善Ⅱ～Ⅲ级者2例;2例A级其神经功能恢复不明显;2例E级者其神经功能手术前后无明显变化。结论EMI-VATS行椎管减压、前路植骨与内固定,与传统开放脊柱前路和"锁孔"胸腔镜手术比较,具有开孔少、操作简单、组织创伤小、出血量少和对上肢功能无明显影响等优势;适合不同时期骨折病人,但微创器械尚需完善。Objective To evaluate the feasibility and characteristics of operation on thoracolumbar vertebra fracture treated with anterior approach surgery by EMI-VATS. Methods Nine cases with thoracolumbar vertebra burst fracture and 2 cases with fracture dislocation were treated with spinal canal decompression and bone grafting by EMI-VATS from march 2005 to may 2006, with an average age of 39 years, 6 cases were treated in one week after injury, 3 were treated in two weeks after injury, 2 were treated in three weeks after injury. Results The average volume of bleeding in the operation was 600 ml, the average time of the operation was 150 min, the postoperative average drainage was 360 ml, the drainage tube was taken out at 55 hours after operation, and patients suffered from transient intercostals nerve pain（ n =1 ）and pulmonary atelectasis（n = 1 ）, pleural effusion（ n = 1 ）. Through 43 days to 25 months＇ postoperative follow-up, the shape of spine was similar to normal, no fracture and laminate subsidence, and no affection on the function of upper limbs. Outcome in neural function was evaluated with Frankel classifications, 5 cases with improved grade 1, 2 cases with improved grade 2-3, 2 cases of a grade with little recovery, and 2 cases of grade E without recovery. Conclusion In the treatment of thoracic spine diseases, surgery assisted by EMI-VATS is better than traditional spine anterior operation and ＂lock hole＂ video-assisted thoracoscopic surgery, which is evidenced by decreasing cut, soft tissue trauma, bleeding volume and upper limbs extremity dysfunction. EMI-VATS is fit for different period vertebra burst fracture. But the appliance stillneeds to be consummated.

关 键 词：胸腔镜 脊柱 骨折 小切口 前路手术 

分 类 号：R687.3[医药卫生—骨科学]