借助胸腔镜技术的胸段、上腰段脊柱前路手术

目的探讨胸腔镜辅助胸椎、上腰椎前路手术的适应证 ,单肺或双肺通气的选择以及术中注意事项。方法　应用胸腔镜、骨科常规手术器械或自制的骨科器械 ,在胸腔镜辅助下行病灶清除、脊髓减压、植骨、钢板螺丝钉内固定术。结果　全部病例手术都顺利完成 ,切口均一期愈合 ,随访 3～ 10个月 ,影像学检查显示病灶清除彻底 ,脊髓减压充分 ,除 1例骨折复位、固定后仍有轻度侧方成角畸形外 ,其他病例复位满意、内固定可靠 ,位置良好。结论胸椎、上腰椎疾患 ,不论是否并发脊髓、马尾神经压迫 ,都能在胸腔镜辅助下完成病灶清除术 ,必要时还可进行脊髓减压、脊柱前路植骨、内固定手术。原则上可选择常规气管插管、双肺通气下完成手术。

Thoracoscope-assisted anterior approach to thoracic spine and upper lumbar spine

Objective To discuss the indication and technique including the selection of one- or two- lung ventilation for the anterior approach with video-assisted thoracoscopic surgery (VATS) to the thoracic spine and upper lumbar spine.Methods 5 patients TB (T₆~L₂) underwent VATS for the cleaning of tuberculous focus,they were implanted primarily with bone or not.3 patients with T₁₀ ~T₁₂ burst fracture,one patient with L₁ old and burst fracture,accompanied with cauda equina syndrome who was treated with decompression of spinal cord,auto-iliac bonegraft and plate screw internal fixation;One patient with thoracic disc herniation(T_3,4),who was treated with anterior decompression and interbody fusion. Results On follow up, the incision in all patients had got primary healing, and the clinical symptoms were improved significantly;the focus were cleaned thouroughly with the spinal cord being decompressed satisfactory and reducted entirely.Plain X-ray and CT of spine showed that the internal fixation was stable,and the grafted bones were at the appropriate position.Conclusion The VATS is suitable for the patients with the TB in thoracic spine and upper lumbar spine and the fracture accompanied with cauda equina syndrome and compression of spinal cord.The procedure is to proceed the focus cleaning, then to decompress the spinal cord, and then to perform the spinal anterior internal fixation. The surgical approach for the T₁₂~L₂section can be done under general anesthesia with endotracheal intubation and two-lung ventilation.