Kossmann T, Ertel W, Platz A, Trentz O
Klinik für Unfallchirurgie, Departement Chirurgie, Universitätsspital Zürich.
Orthopade. 1999 May;28(5):432-40. doi: 10.1007/s001320050368.
The combined intervention of thoracolumbar fractures using the graft inlay technique. Instable fractures of the thoracolumbar junction must be reduced in an open or closed fashion and fixed internally. Clearance of the spinal channel in case of obstruction is mandatory followed by reconstruction of the anterior part of the spine. Using the combined interventions of transpedicular screw techniques and antero-lateral approaches (transthoracal or retroperitoneal) instable fractures of the thoracolumbar junction can be fixed in comparison to the dorsal intervention the anterior approach is very demanding. The proximity of the big vessels as well as thoracal and abdominal organs and the available space to place the implants need exact preoperative planning. The indications for reconstruction of the anterior part of the spine are influenced by the fracture types and localisations as well as biomechanical considerations. One of the many possibilities to reconstruct the anterior part of the spine is the graft inlay technique, which can be used for mono- or bisegmental spondylodesis. Despite the biological advantages in terms of fusion rates substantial complications can occur using this method for anterior reconstruction of the spine.
采用植骨嵌入技术治疗胸腰椎骨折的联合干预。胸腰段交界处的不稳定骨折必须以开放或闭合方式进行复位并内固定。如有椎管梗阻，必须清除椎管，随后重建脊柱前部。采用经椎弓根螺钉技术和前外侧入路（经胸或腹膜后）的联合干预方法，与后路干预相比，胸腰段交界处的不稳定骨折能够得到固定，但前路手术要求很高。大血管以及胸腹部器官的毗邻关系和植入物的可用空间需要精确的术前规划。脊柱前部重建的指征受骨折类型、部位以及生物力学因素的影响。重建脊柱前部的众多方法之一是植骨嵌入技术，该技术可用于单节段或双节段椎体融合术。尽管在融合率方面具有生物学优势，但使用这种方法进行脊柱前路重建可能会出现严重并发症。
