摘要
目的探讨标准锁孔技术行胸（腹）腔镜下脊柱内固定的技术难点及对策。方法2004年7月-2005年9月，我院对6例T5-L4椎体病变采用单肺通气、胸腔镜锁孔技术，行病灶椎体切除减压、髂骨或钛网植骨、Z—plate钢板或CD-Horizon固定，其中结核2例。2例L2-L3结核采用腹膜后不充气入路腹腔镜锁孔技术，行病灶椎体切除、髂骨植骨、Z-plate钢板固定。结核病变术前抗结核治疗5周，术后继续抗结核治疗半年。结果8例施行病灶清除及椎管前壁减压，7例行Z-plate钢板内固定，1例行CD-Horizon内固定。髂骨植骨5例，钛网植骨3例。手术时间6．5—12．6h，平均8．7h。术中出血量250—1800ml，平均950ml。Cobb角矫正5°-18°，平均12°。8例随访时间2～13个月，平均7．4月，5例伴神经损伤者功能恢复1-2级（Frankel分级），1例T7转移性腺癌术后6个月钛网植骨未愈合，Cobb角丢失4°。结论采用标准锁孔腔镜技术进行T5-L3椎体内固定是可行的，手术关键是入口准确定位，节段血管处理，椎管前壁切除等技术难点的对策。
Objective To discuss difficulties and techniques of standard video-assisted thoracoscopic or laparoscopic surgery （SVATS or SVALS） for spine internal fixation. Methods Between July 2004 and September 2005, 6 cases of vertebral lesions located in the T5 - L1 segment （ including 2 cases of vertebral tuberculosis） were given SVATS under single-lung ventilation for resection of diseased vertebral body, reconstruction with autograft or titanium mesh cage, and fixation with the Z-plate system or the CD-Horizon system. Other 2 cases of vertebral tuberculosis located in the L2 - L3 segment underwent retroperitoneal gasless SVALS for lesion debridement, reconstruction with autograft, and fixation with the Z-plate system. For cases of vertebral tuberculosis, anti-tuberculosis drugs were administrated preoperatively for 3 weeks and postoperatively for 6 months. Results The lesion debridement and anterior decompression was completed in all the 8 cases, including internal fixation with the Z-Plate system in 7 cases and with the CD-Horizon system in 1 case. There were 5 cases of iliac autografting and 3 cases of titanium mesh cage reconstruction. The operative time was 6. 5 -12.6 h （mean, 8.7 h） and the blood loss during surgery was 250 - 1 800 ml （mean, 950 ml）. The correction of the Cobb angle was 5°- 18° （mean, 12°）. During a follow-up period for 2 - 13 months （ mean, 7.4 months） in the 8 cases, nerve functions recovered by 1 - 2 Frankel grade in 5 cases, of metastatic adenocarcinoma at the T7 segment. Conclusions and the Cobb angle lost by 4° at 6 months postoperatively in 1 case Spine internal fixation of T5 - L3 segment can be conducted successfully with SVATS or SVALS. The key to the question is accurate orientation of the port site, proper hemostasis of the segment blood vessel, and careful resection of the anterior wall of the vertebral canal.
出处
《中国微创外科杂志》
CSCD
2006年第4期282-284,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
胸腔镜
腹腔镜
脊柱
结核
肿瘤
内固定
Thoracoscopy
Laparoscopy
Spine
Tuberculosis
Tumor
Internal fixation
