胸腔镜或头灯光源辅助的小切口胸腰椎前路手术

目的：探讨胸腔镜或头灯光源辅助下小切口胸腰椎前路病灶清除和重建术的疗效及并发症。方法：63例胸腰椎疾病患者，胸腰椎爆裂性骨折25例，胸腰椎结核28例（均伴有腰椎冷脓肿或死骨），胸腰椎转移性肿瘤6例，嗜酸性肉芽肿1例，动脉瘤样骨囊肿1例，胸椎间盘突出症2例。神经功能Frankel分级：A级4例，B级4例，C级5例．D绒8例，E级42例。采用胸腔镜光源辅助下小切口手术35例，头灯光源辅助下小切口手术28例。病灶清除重建植骨术24例，病灶清除植骨钉板内固定39例。结果：切口长度5．7cm，平均5．8cm。平均手术时间210min，平均术中小血量650ml。术后神经功能A级4例，B级1例，C级2例，D级10例。E级46例。并发胸腔积液2例，肺不张2例，脑脊液漏1例，股外侧皮神经或肋间神经损害7例，经治疗均治愈。42例获半年～2年，平均1.1年随访，无植骨脱出或内固定失效，植骨均获愈合，畸形得到矫正，结核无复发，1例转移性肿瘤复发。结论：光源辅助下小切口腰腰椎前路手术克服了常规开胸手术切口长、创伤大、术后恢复慢等缺点，同时也克服了标准“锁孔”胸腔镜技术操作口过小、完全镜下操作、技术要求高、不易推广等缺点．是并发症较少、便于推广的较安全微创技术。

Anterior approach and small-incision for thoracic-lumbar spine surgery assisted by thoracoscope or headlight

Objective:To explore the effect and complications of anterior approach and small- incision assistedby thoracoscope or headlight for diseases of thoracic- lumbar vertebra.Method:63 cases with thoracic- lumbardisease were reviewed,25 cases of bursting fracture,28 cases of tuberculosis all accompanied with cold ab-scess or bone sequestrum,6 cases of metastatic tumors,1 case of eosinophilic granuloma and 1 case of a-neurysmal bone cyst respectively,2 cases of thoracic disc herniation.35 cases were completed with small oper-ational incision assisted by thoracoscope,the other 28 cases were completed with small incision assisted byheadlight.24 cases were operated by way of lesion removed and no internal fixation,the other 39 cases wereoperated by lesion removed and internal fixation with plate.Result:The average length of incision was 5.8cm.The average operation time was 210min and average volume of bleeding 650ml.2 cases with pleural effusion,2cases with pulmonary atelectasis,7 cases with lesion of lateral femoral cutaneous nerve or intercostal nerve,1case with leakage of cerebrospinal fluid.All these complications took a favorable turn after positive treatment.42 cases were followed up with an average time of 1.1 years.No shedding bone graft or failed internal fixationwas founded.All cases had certain spinal fusion and rectification of abnormity.No recurrence of tuberculosisand one metastatic tumor recurrence was found.Conclusion:Surgery introduced by the article belongs to mini-mal invasive spinal surgery and has advantages of gentle tissue damage,few complications and low demand forinstrument.