Madi K, Dehoux E, Aunoble S, Le Huec J C
Service d'Orthopédie, CHU Maison Blanche, Reims.
Rev Chir Orthop Reparatrice Appar Mot. 2005 Dec;91(8):702-8. doi: 10.1016/s0035-1040(05)84480-0.
There are several solutions for the treatment of fractures of the thoracolumbar junction (classical anterior, posterior, combined approaches). The advent of video-assisted minimally invasive techniques has helped minimize complications. The aim of this work was to analyze the clinical and radiological outcome in a prospective series of 20 patients who underwent video-assisted mini-thoracotomy for the treatment of thoracolumbar junction fractures.
This prospective study included 20 patients, mean age 43.3 years, with at least one year follow-up. All patients presented a normal neurological examination (Frankel E). Fractures were classified Magerl A (n = 19) and B (n = 1). Corporectomy/correction (aided with an endodistractor in the last nine cases) was performed with grafting and osteosynthesis. Perioperative and postoperative complications were noted. Focal kyphosis and regional angulation were noted before and after the operation and at last follow-up using the Stagnara system.
The arthrodesis had fused at last follow-up in all patients. There were three cases of alelectasia which regressed in two months. Overall outcome showed satisfactory angular correction which was maintained at last follow-up. The gain in focal kyphosis was 13.71 degrees on average in the immediate postoperative period and persisted at last follow-up (13.31degrees). The gain in corrected regional angulation was 14 degrees in the immediate postoperative period and 14 degrees at last follow-up. The gain in focal kyphosis and regional angulation was two-fold greater with the endodistractor than with external maneuvers.
The complication rate was very low. Corrections obtained were comparable with those reported in the literature and persisted over time.
Bearing in mind the learning curve, there are fewer complications with the video-assisted minimally invasive approach than with classical thoracotomy or anterior surgery. This is true for perioperative and early and late postoperative complications. The correction achieved is satisfactory and lasting. A specific ancillary is essential for the reduction and for fitting the anterior graft without lost of correction. This technique combines the best results achieved with thoracotomy (Onimus) with a limited rate of complications.
胸腰段交界处骨折有多种治疗方法（经典前路、后路、联合入路）。视频辅助微创技术的出现有助于减少并发症。本研究的目的是分析20例行视频辅助小切口开胸术治疗胸腰段交界处骨折患者的前瞻性系列研究的临床和影像学结果。
本前瞻性研究纳入20例患者，平均年龄43.3岁，随访至少1年。所有患者神经学检查正常（Frankel E级）。骨折分类为Magerl A型（n = 19）和B型（n = 1）。行椎体切除/矫正术（最后9例使用内撑开器辅助）并植骨及内固定。记录围手术期和术后并发症。使用Stagnara系统在术前、术后及最后随访时记录局部后凸和节段性成角情况。
所有患者在最后随访时均实现了融合。有3例肺不张，2个月后消退。总体结果显示角度矫正满意，且在最后随访时得以维持。术后即刻局部后凸平均增加13.71度，在最后随访时仍持续（13.31度）。术后即刻矫正节段性成角增加14度，最后随访时为14度。使用内撑开器时局部后凸和节段性成角增加幅度是外部操作的两倍。
并发症发生率非常低。获得的矫正效果与文献报道相当且随时间持续存在。
考虑到学习曲线，视频辅助微创入路的并发症比经典开胸术或前路手术少。围手术期及术后早期和晚期并发症均如此。实现的矫正效果满意且持久。一种特殊的辅助器械对于复位和植入前路植骨且不丢失矫正至关重要。该技术结合了开胸术（Onimus）取得的最佳效果且并发症发生率有限。
