腹腔镜辅助下腰椎骨折前路减压内固定术

目的探讨在腹腔镜辅助下，经腹膜后腰肌间隙人路的小切口对腰椎爆裂性骨折椎管减压、植骨、内固定手术的可行性。方法13例腰椎爆裂性骨折，在腹腔镜辅助下经腹膜后腰肌间隙入路，应用腹腔镜、自制手术器械，进行椎体爆裂性骨折并脊髓圆锥、马尾神经压迫症病例的椎管减压、植骨、内固定手术。结果全部病例切口Ⅰ期愈合，椎管内骨块清除彻底。椎管减压充分，植骨块融合良好，内固定器无松动；1例L4椎体爆裂性骨折、马尾神经受压病例同时还伴有T6骨折、完全性截瘫，术后脊髓功能未恢复；4例圆锥、马尾神经受压，术后功能基本恢复。结论腹腔镜辅助下经腹膜后腰肌间隙人路的小切口腰椎手术，可以完成椎体爆裂性骨折并脊髓圆锥、马尾神经压迫症的椎管减压、植骨、内固定术。

Laparoscope assisted anterior decompression and internal fixation for lumbar vertebra fractures

Objective To study the possibility of treatment for lumbar spine burst fracture via retroperitoneal approach through the space of major psoas muscle and the quadratus lumborum processes by minimally invasive video-assisted laparoscope. Methods Through the psoas space treatment with minimally invasive video-assisted laparoscopic were performed in 13 patients with lumbar spine burst fracture and conus medullaris injury or cauda equina syndrome by the operation of vertebral canal decompression,auto-iliac bonegraft and internal fixation. Results All the patients acquired satisfactory incision healing, thorough cleaning of bone block in spinal cords, sulficient decompression of vertebral canal, apopriate fusion of bone graft, and no internal fixation failure was found. In one case with L4 burst fracture and the compression of cauda equina associated with T6 fracture and paraplegia,the postoperative neurological function was not improved. In four cases with compression of conus medullaris and cauda equine ,the postoperative neurological function had remarkable recovery. Conclusion The laparoscope assisted minimally invasive operation through the psoas space approach can achieve the depression of vertebral canal,internal fixation and iliac bone autograft in treatment of lumbar spine burst fracture, conus medullaris injury and cauda equina syndrome.