胸腔镜辅助下胸椎、上腰椎前路手术的体会

目的 探讨胸腔镜技术在胸、腰椎前路手术的适应证、操作要点以及单肺或双肺通气麻醉的选择。方法 对5例结核病人行胸腔镜下结核病灶清除术，其中2例同时行自体髂骨植骨术，1例以自固化磷酸钙人工骨(CPC)植入；对3例爆裂性骨折截瘫及1例L1陈旧性爆裂骨折并马尾综合征病人进行脊髓减压、自体髂骨植骨、钢板螺丝钉内固定术。结果 全部病例都得到随访，术后切口一期愈合，X光、CT检查也都显示病灶清除彻底，脊髓减压充分，复位满意，内固定可靠，位置良好。结论 胸椎、上腰椎结核或骨折，不论是否并发脊髓、马尾神经压迫的病例，均适宜在胸腔镜辅助下进行病灶清除、脊髓减压、脊柱前路内固定术。

Anterior surgery with video-assisted thoracoscopic surgery for the treatment of thoracic spine and upper lumbar spine

Objective To discuss the application and surgical technique of anterior surgery with video-assisted thoracoscopic surgery for the treatment of thoracic spine and upper lumbar spine.Methods Five patients with tuberculosis underwent VATS for the cleaning of tuberculous focus:2 cases of TB in T 6,7and T 9,10were implanted primarily with auto-iliac bone and one case of TB in T12 L1 was implanted with CPC.Three cases of burst fracture in T 10,11and one case of old burst fracture in L1 accompanied with cauda equina syndrome were treated with decompression of spinal cord, auto-iliac bonegraft and plate screw internal fixation.Results All patients were followed up.The incision primary healing and clinical symptoms were improved significantly.The focus were cleaned thoroughly,the spinal cord was decompressed enough,the reduction was satisfactory,the internal fixation was stable and the position of grafted bones was good by X-ray and CT.Conclusion VATS is suitable for the patients with thoracic spine and upper lumbar spine TB and fracture accompanied with cauda equina syndrome and compression of spinal cord in focus cleaning,decompression of spinal cord,spinal anterior internal fixation.