胸腔镜辅助小切口手术与传统脊柱前路手术治疗胸腰椎骨折的病例回顾分析

目的:探讨胸腔镜辅助小切口手术治疗胸腰椎骨折的安全性与有效性。方法:对2000年10月至2009年12月应用胸腔镜辅助小切口手术和传统脊柱前路手术治疗的44例胸腰椎骨折患者进行回顾性分析。胸腔镜辅助组23例,男15例,女8例;年龄19～76岁,平均41.4岁。传统手术组21例,男14例,女7例;年龄20～74岁,平均39.3岁。两组患者均行伤椎椎管前路减压、自体髂骨植骨、前路内固定术。平均随访时间18个月(6～36个月)。比较两组患者的手术时间、出血量、术后伤椎椎管侵占率的下降值、Cobb角矫正度、Cobb角丢失度、ASIA评分改善情况的差异。结果:手术时间、术中出血量、伤椎椎管侵占率的下降值、Cobb角的矫正度、Cobb角的丢失度、ASIA评分改善级数传统手术组分别为:(150.0±19.4)min、(970.0±72.0)ml、(35.5±6.4)%、(25.1±4.8)°、(1.0±0.7)°、(1.8±0.9)级;胸腔镜辅助组分别为(170.0±20.8)min、(650.0±65.4)ml、(33.2±8.0)%、(23.6±5.4)°、(1.1±0.8)°、(2.0±1.1)级。两组患者术中出血量差异有统计学意义(P<0.05);而手术时间、术后伤椎椎管侵占率的下降值、Cobb角的矫正度、Cobb角的丢失度、ASIA评分改善级数无明显差异(P﹥0.05)。术后1年两组融合率均为100%。结论:胸腔镜辅助小切口手术与传统脊柱前路手术相比,切口小,术中出血少,手术创伤小,疗效相似,是治疗胸腰椎骨折的一种有效、安全的手术方式。

Retrospective study on treating thoracolumbar fractures with video-assisted thoracoscopic surgery and traditional anterior approach surgery

Objective: To investigate the feasibility and the efficacy of video-assisted thoracoscopic surgery in treating thoracolumbar fractures. Methods: From October 2000 to December 2009,the data of 44 patients with thoracolumbar fractures were retrospetively analyzed. All patients were treated with anterior decompression,auto-iliac bone graft and anterior internal fixation system. They were divided into thoracoscopic group(23 cases,treated with video-assisted thoracoscopic surgery) and traditional group (21 cases,treated with traditional anterior approach surgery). In the thoracoscopic group,there were 15 males and 8 females with an average age of 41.4 years (ranged,19 to 76);and in the traditional group,there were 14 males and 7 females with an average age of 39.3 years (ranged,20 to 74). All patients were followed up from 6 to 36 months with an average of 18 months. The operative time,volume of the blood loss,the decreased value of the occupation ratio of spinal canal (OR),the corrected and loss degree of Cobb angle,the improved condition of ASIA classification were compared between two groups. Results: In traditional group,operative time,volume of the blood loss,the decreased value of the occupation ratio of spinal canal (OR),the corrected and loss degree of Cobb angle,the improved grade of ASIA classification were (150.0±19.4) min,(970.0±72.0) ml,(35.5±6.4)%,(25.1±4.8) °,(1.0±0.7)°,(1.8±0.9) grades,respectively;and in thoracoscopic group,the above items were (170.0±20.8) min,(650.0±65.4) ml,(33.2±8.0)%,(23.6±5.4) °,(1.1±0.8)°,(2.0±1.1) grades,respectively. There was significant difference in volume of the blood loss between two groups(P < 0.05);there was no significant difference in operative time,the decreased value of the occupation ratio of spinal canal(OR),the corrected and loss degree of Cobb angle,the improved grade of ASIA classification between two groups(P > 0.05). The rate of fusion of all patients was 100%. Conclusion: Compared with the traditional anterior approach surgery,video-assisted thoracoscopic surgery has advantages of little incision,less blood loss,less trauma,can obtain same clinical outcome and is a safe,effective method in treating thoracolumbar fractures.