后路内窥镜下(Xtube)椎弓根螺钉内固定 治疗胸腰椎骨折.docVIP

后路内窥镜下(Xtube)椎弓根螺钉内固定 治疗胸腰椎骨折 论文联盟www.LWLM.com编辑。 作者：刘好源，黄建明，林金堆，陈峰嵘，简国坚，龚灏，徐天睿 【摘要】 ［目的］探讨微创技术 治疗 胸腰椎骨折的适应证和初步体会。［方法］选择21例单纯胸腰椎骨折、不伴有神经损伤、无需行椎板减压的损伤，在C型臂X线机定位下行胸腰椎骨折上下位椎椎弓根螺钉内固定，手术采用棘突中轴线旁开2 cm各做一个切口长3 cm，固定和复位均在这4个小切口内完成。［结果］21例患者经术后12～18个月(平均14个月)随访，X线片示骨折椎体均获得良好复位及固定，患者腰部功能恢复良好。［结论］后路内窥镜下(Xtube)胸腰椎骨折椎弓根螺钉复位内固定术与传统手术相比，技术操作难度并不太大，适用于单纯胸腰椎骨折、不伴有神经损伤、无需行椎板减压的患者，具有手术切口小、出血少、恢复快等优点。 【关键词】 胸腰椎骨折； 内固定； 内窥镜； 微创脊柱外科 Abstract：［Objective］To investigate the clinical effects of the treatment of thoracolurnbar fracture with pedicle screw system under endoscopy assisted Xtube system.［Method］Twentyone cases of pure thracolumbar fracture without neural impairment were treated with pedicle screw system under endoscopy assisted Xtube system.With the image intensifier,the pedicle based in the affected segments were localized and exposed through 4 small incisions (3cm).Transpedicular fixation and reduction by endoscopy assisted Xtube system were performed through the 4 small incisions.［Result］Twentyone cases were followed up for 12-18 months (averaged,14 months).Radiography showed good reduction fixation of the vertebral bodies,good correction of the kyphosis deformities and good restoration of lumbar motion.［Conclusion］The treatment of thoracolumbar fracture with pedicle screw system under endoscopy assisted Xtube system is indicated for thoracolumbar fracture without neural impairment.This technique has advantages of minimal invasion and early functional recovery. Key words：thoracolumbar fracture; internal fixation; endoscopy; minimal invasive spinal surgery 微创脊柱外科在国内尚在探索阶段，用后路内窥镜下行椎弓根螺钉复位内固定术的微创技术治疗胸腰椎骨折目前报道较少［１］。从2006年6月笔者在椎间盘镜下(Xtube)行胸腰椎骨折椎弓根螺钉复位内固定治疗21例，取得一定的体会。 1 材料与方法 1.1 一般资料 本组21例，男13例，女8例；年龄19～47岁，平均32岁；T12 5例，L1 11例，L2 4例，L3 1例。 1.2 手术方法 麻醉成功后，患者取俯卧位。首先用C型臂X线机定位骨折椎的上、下位椎椎弓根根部，用记号笔做体表标记。常规消毒铺巾，以上、下位椎的4个椎弓根根部为中心，棘突中轴线二侧各旁开2 cm做4个3 cm长切口。切开皮肤和深筋膜。沿导针依次进扩张管最后进Xtube通道管，撑开器撑开Xtube的2个叶片扩大深部通道，自由臂固定通道管，连接冷光源光纤及内突窥镜系统。用长柄电刀、双极电凝、刮匙清除管道内残余肌肉和软组织，显露关节突根部或乳突部。