经胸膜外保留肋骨脊髓前方减压融合内固定治疗胸腰椎疾病  

Extrapleural anterior decompression with preservation of ribs combined with bone graft fusion and internal fixation for treatment of thorcolumbar diseases.

作　　者：徐昌华[1] 廖鸿[2] 陈德龙[2] 蒲红尧 林爱国[2] 

机构地区：[1]四川省中医研究院 [2]遂宁市红十字医院,629000

出　　处：《四川医学》2000年第8期675-677,共3页Sichuan Medical Journal

摘　　要：目的　报告胸腰段椎体骨折、骨折脱位、结核及肿瘤引起胸腰段脊髓受压 ,采用经胸膜外保留肋骨脊髓前减压、植骨融合及内固定的处理经验。方法　右侧侧卧位 ,以病椎为中心“)”型切口 ,游离 1～ 3条肋骨 ,保留肋间神经及血管 ,于横突尖端切断肋骨 ,远端肋骨不切断 ,将壁层胸膜椎向前方 ,显露多个椎体 ,切除病椎及椎间盘组织 ,显露脊髓 ,椎体间嵌入“T”型骨块 ,安放内固定 ,将切断之肋骨复位 ,肋骨断端钻孔用尼龙线固定。结果　 62例病例中胸腰段骨折 ,骨折脱位合并脊髓损伤 47例。胸腰段结核合并脊髓损伤 1 4例。胸腰段肿瘤合并脊髓损伤 1例。术后半年至 1 1年随访 ,神经功能按照 Fronkle分级均有不同程度的恢复 ,肋骨术后 3月 X线片显示达解剖愈合 ,椎体间植骨达骨性融合、椎体间内固定物无断钉及钉退出现象。结论　经胸膜外保留肋骨脊髓前方减压、植骨融合 。Objective This paper reports the authors experience with the procedure of extrapleural anterior decompression with preservation of ribs combined with bone graft fusion and internal fixation to treat thoracolumbar spinal cord compression caused by thoracolumbar fractures,fracture dislocations,tuberculosis and tumors.Methodss Put the patient in right lateral recumbent position.A “J” shaped incision is made around the central point of the defective vertebra and 1～3 ribs are freed with preservation of intercostal nerves and vessels.At the transverse tip,rib is dissected but the other end is left uncut.By pushing the parietal layer of pleura forward,several vertebras can be revealed.After the removal of defective vertebras and intervertebral disctissues,the spinal cords are exposed and a “T” shaped bone graft is inserted in and fixed with internal fixation devices.The cut ribs are then relocated by drilling holes on the ends and fixed with nylon thread.Results Among 62 cases,47were those of thoracolumbar fractures,fracture dislocations complicated with spinal cord injuries,14 were the cases of thoracolumbar tuberculosis with the same complication,and 1 was a case of thoracolumbar tumor with the same complication.At the follow up 0.5～12 years after the procedure,all of the patients recovered to some extent according to Frankle Grades for functions of nerve system.The healing of ribs reached the anatomical stage according to X ray demonstration 3 months after the operation and the bone graft between vertebras reached the bony stage without the signs of any broken nails or any withdrawal of nails.Conclusion The procedure of extrapleural anterior decompression with preservation of ribs combined with bone graft fusion and internal fixation is a good way to t

关 键 词：胸腰椎骨折 脱位 兴髓前方减压 内固定 植骨 

分 类 号：R681.5[医药卫生—骨科学]