脊柱胸腰段疾病手术经膈肌胸膜外前入路的临床应用

目的探讨前路经膈肌胸膜外前入路在治疗胸腰段脊柱病变手术中的应用，研究手术入路技巧和相关并发症的防范。方法通过回顾性分析29例胸腰段病变的患者，采用前路切除第11肋的经膈肌胸膜外前切口，暴露胸腰段椎体，施行各类脊柱手术。结果本组平均手术时间为3小时20分钟，病灶清除彻底，螺钉位置理想。无术后伤口感染、气胸及乳糜胸发生。29例平均随访19个月，无钢板断裂、植骨不融合、脊柱后凸畸形等并发症发生。结论此手术切口比邻重要组织器官，手术风险较大，但只要医生熟悉局部解剖是安全的。此入路对组织损伤小，手术视野好，术后并发症少，适用于胸腰段脊椎病变的手术。

The clinical application of transdiaphrag-matic extrapleural anterior approach for thoracolumbar spinal diseases

The Clinical Application Of Retroperitoneal Lextrapleural Anterior Approach For Thoracolumbar Spine Via Diaphragam YongHang-Cai,Ying-Zhang,TingGuang-Luo,RongQing-Huang,ZhengYong-Luo,ZenHong-Li (1.The Department of orthopedics,the People's Hospital of YunXian,YunXian 675800,YunNan,china. 2. The Department of orthopedics,The 2nd Afflicated hospital of KunMing medical college, KunMing 650101,YunNan,China) Abstract: Objective To introduce the clinical application of retroperitoneal lextrapleural anterior approach for thoracolumbar spine via diaphragam in thoracolumbar spine disease treatment. Investigate the surgical techniques and the complications .Method 29 patiants with thoracolumbar spine disease were operated with retroperitoneal lextrapleural anterior approach for thoracolumbar spine via diaphragam with remove the 11 rib .The operating field was exposed well with less bleeding. Result The average time for surgical exposure was 30-60 minutes. No pneumothorax and chylothorax in this group. The average time of follow-up was 19 months. There was no complications such as plate abruption,nounion and kyphosis.Conclusion The incision is safe as long as familiar with the anatomy. This approach is suitable for thoracolumbar spinal lesions with less invasion and better exposure. Key word incision, diaphragam