胸腰段脊椎前路手术解剖与临床应用

目的：探讨胸腰段脊椎（T10~L3）前路手术入路局部解剖结构指导前路椎体次全切除减压植骨内固定的临床效果。方法通过对10具（男性6具、女性4具）成人尸体标本进行胸腰段脊椎（T12~L3）进行解剖学研究，并于2010年1月~2013年10月对30例脊髓压迫主要来自于椎管前方的胸腰段椎体暴散性骨折病人行胸腰段前路减压植骨内固定术。其中，男21例，女9例；年龄20~65岁，平均38.5岁。均采用右侧卧位、左侧入路，切除左第十一肋骨，行T12、或L1、L2椎体次全切除植骨内固定术，其中T125例，L112例、L213例，所有病例均行相隔一个椎体、短节段固定。观察手术时间中出血并发症发生以及术后随访对比分析，观察植骨融合情况。结果平均手术时间（1.8±1.3）h，平均术中出血量（400~2100）800mL，术中胸腹损伤5例，术后胸腔引流3例，无大血管损伤及内脏脏器损伤，无脊髓神经损伤加重病例。随访6~46个月，平均20个月。所有病例均获满意复位，随访期间无复位丢失，内固定位置佳，无松动断裂，均于5个月获得骨性融合，融合率为100%。结论对于胸腰段（T12~L2）椎体暴裂性骨折，脊髓压迫主要来自于椎管前方，熟悉脊椎前入路局部解剖，掌握前路技术要点，采用前入路行椎体次全切除植骨内固定术，能够有效缩短手术时间。减少出血量及并发症发生，脊髓减压确实，术中植骨融合率高，手术效果好。

Anatomy of thoracolumbar spinal cord anterior operation and its clinical application

Objective To Study the clinical effect of the thoracolumbar Anterior Operation （T10-L3） approach anatomy guidance anterior corpectomy decompression bone internal fixation. Methods Based on the anatomy, study of the thoracolumbar spine （T12-L3） of 10 （male 6, female 4） adult cadaveric specimens, and 30 cases of patients with spinal cord compression mainly from anterior thoracolumbar burst fracture from 2010 January to 2013 October were given scattered thoracolumbar anterior decompression bone grafting and internal fixation. Among them, 21 cases were male, 9 cases were female; age was 20-65 years old, average age was 38.5 years old. Adopted the right lateral, left approach, resection of the left eleventh rib, subtotal resection body bone graft and internal fixation of T12, or L1, L2 vertebral, in which 5 cases of T12,12 cases of L1 , 13 cases of L2, all cases were given short segment fixation separated by a vertebral body, the bleeding complications during operation time and the postoperative follow-up were comparative analyzed, bone graft fusion condition was observation. Results The average operation time was （1.8±1.3） h, the average amount of bleeding during operation was800mL（400-2100mL） , 5 cases of patients got the thoracic and abdominal injury during operation, 3 cases of thoracic drainage after operation, no damage and visceral organs of major vascular injury, and no spinal cord injury aggravated cases. The time of follow-up was 6-46 months, average time was 20 months. All cases got satisfactory reduction, there were no loss of reduction during the follow-up period, fixed position was good, no loosening or fracture, both achieved bony fusion in 5 months, the fusion rate was 100%. Conclusion For the thoracolumbar（T12-L2） vertebral burst fractures, spinal cord compression mainly from anterior spinal anterior approach, familiar with local anatomy, master the techniques of using anterior, anterior approach for subtotal resection of vertebral body bone graft and internal fixation, can ef