上胸椎骨折脱位经胸入路的手术方法探讨

目的探讨上胸椎骨折脱位经胸入路手术治疗的显露效果和临床疗效。方法对12例上胸椎骨折脱位患者采用经胸入路椎体切除椎管减压椎间植骨侧前方内固定,术中次全切除病椎,椎间取髂骨植骨,钉棒系统内固定。分别用后凸角度和Frankel分级评价脊柱畸形矫正效果和脊髓恢复。结果12例患者中2例失访,10例随访时间3~20个月,术后随访无内固定折断,螺钉拔出或内固定棒折弯等并发症。在最后一次随访按Frankel分级评估,术前A级4例,恢复到B级1例,3例无明显改善;B级1例恢复到C级;C级2例恢复到D级1例,E级1例。胸椎后凸畸形分别矫正0~23°,平均18.5°。所有患者术后6个月均获得骨性融合。结论经胸入路手术治疗上胸椎损伤可以获得较好的显露,同时达到减压、矫形和脊柱稳定性重建,提高椎间植骨融合率。

Evaluate the surgical methods of the high transthoracic approach in upper thoracic vertebrae with fracture and dislocation

Objective To study the exposure of the high transthoracic approach for anterior decompression and instrumentation at the upper thoracic vertebrae.Methods 12 cases with fracture and dislocation of upper thoracic spine were treated with resecting thoracic vertebral bodies and bone graft for anterolateral internal fixation via transthoracic approach.All cases were fixed by screw-rod fixation system.The cobb angle and Frankel classification were evaluated before and after surgery.Results 10 of 12 patients were followed up from 3 to 20 months.None of the internal fixation was unsatisfied.According to Frankel grading,in 4 of grade A,1 was restored to B,3 had no obvious recovery;1 grade B was restored to C;in 2 cases of grade C,1 was restored to D,1 to E.The cobb angles were improved from 0 to 23 degree,average 18.5 degree.All the patients had consolidation anterior fusions.Conclusion The high transthoracic approach to the upper thoracic vertebrae was a favorable way.The approach provides a better visualization and enough space for anterior decompression and implant,which has a better fusion rate.