| 胸腰段脊柱侧前方改良入路的临床应用 |
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Received:May 10, 2004
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| 作者 | Author | 单位 | Unit | E-Mail |
| 司军 |
SI Jun |
南通医学院附属医院骨科 江苏南通226001 |
Department of Orthopaedics Surgery,the Affiliated Hospital of Nantong Medical College,Jiangsu Nantong,226001,China |
sijun7777@tom.com |
| 成红兵 |
CHENG Hong-bing |
南通医学院附属医院骨科 江苏南通226001 |
Department of Orthopaedics Surgery,the Affiliated Hospital of Nantong Medical College,Jiangsu Nantong,226001,China |
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| 潘丞中 |
PAN Cheng-zhong |
南通医学院附属医院骨科 江苏南通226001 |
Department of Orthopaedics Surgery,the Affiliated Hospital of Nantong Medical College,Jiangsu Nantong,226001,China |
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| 曹涌 |
CAO Yong |
南通医学院附属医院骨科 江苏南通226001 |
Department of Orthopaedics Surgery,the Affiliated Hospital of Nantong Medical College,Jiangsu Nantong,226001,China |
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| 王洪 |
WANG Hong |
南通医学院附属医院骨科 江苏南通226001 |
Department of Orthopaedics Surgery,the Affiliated Hospital of Nantong Medical College,Jiangsu Nantong,226001,China |
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| 胡克苏 |
HU Ke-su |
南通医学院附属医院骨科 江苏南通226001 |
Department of Orthopaedics Surgery,the Affiliated Hospital of Nantong Medical College,Jiangsu Nantong,226001,China |
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| 朱建炜 |
ZHU Jian-wei |
南通医学院附属医院骨科 江苏南通226001 |
Department of Orthopaedics Surgery,the Affiliated Hospital of Nantong Medical College,Jiangsu Nantong,226001,China |
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| 期刊信息：《中国骨伤》2005年18卷，第3期，第137-139页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
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目的:探索胸腰段脊柱侧前方新型入路。
方法:研究胸、腰段层次解剖的差别及复杂肌肉走行、毗邻和神经支配关系,汲取既往入路的各自优点,设计了独特的“┓”形切口、改良的“胸膜外腹膜后”入路。新型入路由同一手术组医生操作,临床应用26例胸腰段疾患,均行减压、植骨及Z形钛钢板内固定。
结果:手术时间75～180min,平均135min,输血量200～800ml,平均423ml。术中无一例胸膜破裂,术后摄片示矫形优良,矢状位指数(sagittalindex,SI)术后平均矫正103°,内固定物植入无一错误,无胸腔积液、深部感染,无脊髓损伤加重,术后恢复快。26例患者中13例获随访8～34个月,未见腰背肌肉失神经表现,内植物无失败,脊髓损伤Frankel分级提高至少1级占83.2%(10/12)。摄片或CT扫描示融合成功,无假关节形成。随访期间SI轻度丢失1°～5°,平均25°。
结论:新型“┓”形切口改良入路适应证广(T11-L2),技术难度低,损伤小,出血少,暴露充分,利于操作,手术时间缩短,还能避免加重脊髓、神经根及胸膜损伤,值得推广。 |
| [关键词]:脊柱 骨科手术方法 胸椎 腰椎 |
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| Clinical application of the modified anterolateral approach to thoracolumbar junction |
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Abstract:
Objective: To explore a new anterolateral approach to the thoracolumbar junction.
Methods:The modified anterolateral approach to thoracolumbar junction was based on the anatomic relation of thoracolumbar spine,and refered to the advantage of different operative methods.The new approach with "┓" shape incision was utilized in twenty-six cases of thoracolumbar diseases by the same surgical team from May 2000 to Aug 2002,and the process was composed of anterolateral decompression,bonegrafting and Z-PLATE TM-ALT fixators.The operations were performed successfully in 26 cases.
Results:The time of the operations was from 75 minutes to 180 minutes（in average of 135 min）.The volume of blood-transfusion was 200 to 800 ml（average 423 ml）.No muscle of the loin was cut,no injury of pleura was found.Except for thirteen patients,other 13 patients were followed up from 8 months to 34 monthes（in average of 20.7 monthes）.Sagittal index（SI） was achieved by 10.3° on the average postoperatively.There was a mild loss（1° to 5°）of SI during follow-up period.No failure of implant was found.Neurological status improved at least one Frankel grade in 83.3%（10/12） of the patients who had preoperative incomplete paraplegia.4 patients were checked with CT scan at final follow-up.The rate of spine solid fusion at the interface between the graft and adjacent vertebral bodies was 100%（13/13）.
Conclusion:The new approach should be recommended because of more indications（T 11-L 2）,less artistry,less injury,less bleeding,less operative time and less complications such as the spinal cord and pleura injury casued by dragging in the operation. |
| KEYWORDS:Spine Orthopaedics operative methods Thoracic vertebrae Lumbar vertebrae |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 司军,成红兵,潘丞中,曹涌,王洪,胡克苏,朱建炜.胸腰段脊柱侧前方改良入路的临床应用[J].中国骨伤,2005,18(3):137~139 |
| 英文格式: | SI Jun,CHENG Hong-bing,PAN Cheng-zhong,CAO Yong,WANG Hong,HU Ke-su,ZHU Jian-wei.Clinical application of the modified anterolateral approach to thoracolumbar junction[J].zhongguo gu shang / China J Orthop Trauma ,2005,18(3):137~139 |
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