胸腔镜辅助小切口手术治疗胸腰椎骨折的影像学与疗效评价  

Imaging analysis and therapeutic effect evaluation of video-assisted thoracoscopic surgery for thoracolumber fracture

作　　者：彭明[1] 曹新峰[1] 彭国栋[1] 马晓程[1] 

机构地区：[1]青岛市市立医院骨科暨青岛市微创脊柱外科中心,266011

出　　处：《疑难病杂志》2011年第10期771-773,共3页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的从影像学及临床疗效方面探讨胸腔镜辅助小切口手术治疗胸腰椎骨折的可行性和有效性方法2000年10月—2009年12月应用胸腔镜辅助小切口手术治疗胸腰椎骨折患者23例,所有患者均行伤椎椎管前路减压、自体髂骨植骨、前路内固定术。随访平均18个月(6～36个月)分别测量患者术前、术后1周、末次随访时Cobb角及伤椎椎管的最短矢状径,计算各时段伤椎椎管侵占率,并进行神经功能评价,观察并发症。结果该组患者手术时间90～240(170±21)min,出血量300～1000(650±65)ml,术前、术后1周、未次随访时伤椎椎管侵占率分别为(38.2±12.7)%、(5.0±3.9)%、(5.4±4.1)%;Cobb角分别为(28.8±7.1)。、(5.2±2.7)。、(6.3±2.8)。术后1周及末次随访伤椎椎管侵占率、Cobb解与术前相比均有明显差异(P<0.05),而末次随访与术后1周无明显差异(P>0.05)。23例患者除ASIA分级为A级的2例无明显改善外,其余患者脊髓功能均有不同程度的恢复,恢复(2.0±1.1)级;术后1年植骨融合率100%。结论胸腔镜辅助小切口手术是治疗胸腰椎骨折的一种有效、安全、微创的手术方式。Objective To investigate the feasibility and the efficacy of video-assisted thoracoseopic surgery for thoracolumbar fracture by imaging analysis and clinical outcome evaluation.Methods Twenty-three patients with thoracolumbar fracture underwent video-assisted thoracoscopic surgery from October 2000 to December 2009.All cases were treated with anterior decompression,autograft and internal fixation with anterior plate fixation system.All cases were followed up from 6 months tn 36 months with an average of 18 months.The sagittal diameter of injured vertebra canal and Cobb angle were measured pre-operation,1 week post-operation and last times follow up.The occupation ratio of spinal canal calculated and Cobb angle preoperatively and postoperatively were analyzed.The clinical outcome of all the patients preoperatively and postoperatively were also analyzed.The postoperative complications were observed.Results The mean operation time was 90～240 （170±21 ） min.The mean blood loss was 300～1000（650±65） ml.The occupation ratio of spinal canal in the preoperative, one week after the operation and final follow-up were（38.2±12.7）%,（5.0±3.9）%and（5.4±4.1 ）%respectively.The Cobb angle were（28.8±7.1 ）°,（5.2±2.7）°and（6.3±2.8）°respectively.The occupation ratio of spinal canal and Cobb angle of one week after the operation and final follow-up were deceased obviously than preoperative（P0.05）,there was no statistical significant difference between final follow-up and one yveek after the operation（P0.05 ）.The spinal cord function of all cases improved different degrees except two cases with A degree according lo ASIA classification.The rate of fusion was 100%1 year after operation.Conclusion It demonstrated that the video-assisted thoraeoseopic surgery was a safe,effective and mini-invasive operation for patients with thoracolumbar fracture.

关 键 词：胸腔镜 胸腰椎骨折 COBB角 椎管侵占率 

分 类 号：R687.3[医药卫生—骨科学]