Hovorka I, de Peretti F, Damon F, Argenson C
Service de Chirurgie Orthopédique, CHU de Nice, Hôpital de l'Archet II, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice.
Rev Chir Orthop Reparatrice Appar Mot. 2001 Feb 1;87(1):73-8.
A minimally invasive anterior approach has been developed for the thoracolumbar junction of the spine. The aim of this study was to evaluate the possibilities of videoscopic treatment of fractures and malunions of the thoracolumbar junction and to report the first results obtained with this technique.
Video-assisted surgery was performed in eleven patients using costal resection and a retropleural and retroperitoneal approach. Anterior arthrodesis was performed in all cases, four with anterior instrumentation. The indications were trauma for six patients and malunion for five.
Mean follow-up was 17.4 months. For malunion patients, the mean angular gain was 22.4 degrees. Radiological anterior fusion was achieved in all cases except one. The mean angular loss was 5.7 degrees.
The surgeon can control the procedures by direct vision, while the assistant follows the operation on the video display screen. The upper par of L1 can be reached via a supradiaphragmatic retropleural approach, while a larger exposure is possible if the insertions of the diaphragm are released and the retroperitoneal space is opened. The crus does not have to be sectioned to expose the lateral part of the thoracolumbar vertebrae. Possible complications are similar to those which can be observed with open procedures.
The videoscopic approach enables the exposure of throacolumbar junction with a smaller parietal lesion than with open procedures. It enables arthrodesis procedures with corporectomay, angular correction and anterior osteosynthesis.
已开发出一种用于脊柱胸腰段交界区的微创前路手术方法。本研究的目的是评估电视辅助治疗胸腰段交界区骨折和畸形愈合的可能性，并报告采用该技术获得的首批结果。
对11例患者采用肋切除及胸膜后和腹膜后入路进行了电视辅助手术。所有病例均进行了前路融合术，其中4例采用前路内固定。适应证为6例创伤患者和5例畸形愈合患者。
平均随访17.4个月。对于畸形愈合患者，平均角度改善为22.4度。除1例外，所有病例均实现了影像学上的前路融合。平均角度丢失为5.7度。
术者可通过直视控制手术过程，助手则在视频显示屏上观看手术。通过膈上胸膜后入路可到达L1上半部分，而如果松解膈肌附着点并打开腹膜后间隙，则可获得更大的暴露范围。为暴露胸腰段椎体外侧部分，无需切断膈肌脚。可能的并发症与开放手术中观察到的并发症相似。
与开放手术相比，电视辅助入路能够以较小的壁层损伤暴露胸腰段交界区。它能够进行椎体切除、角度矫正和前路骨合成的融合手术。
