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经皮椎弓根入路与前路手术治疗胸腰椎体骨折的对比分析:80 例胸腰椎体骨折切除术。

The transpedicular approach compared with the anterior approach: an analysis of 80 thoracolumbar corpectomies.

机构信息

Department of Neurosurgery, University of California, San Francisco, San Francisco, California 94143-0112, USA.

出版信息

J Neurosurg Spine. 2010 Jun;12(6):583-91. doi: 10.3171/2010.1.SPINE09292.

Abstract

OBJECT

Whereas standard anterior approaches for thoracolumbar corpectomies have commonly been used, the transpedicular technique is increasingly used to perform corpectomies from a posterior approach. The authors conducted a study to analyze whether there was a difference in outcomes by comparing transpedicular corpectomies to standard anterior thoracolumbar corpectomies.

METHODS

The senior author performed thoracolumbar corpectomies in 80 patients between 2004 and 2008. The authors reviewed medical records and follow-up data, consisting of clinic visits, radiographs, or telephone interviews. Neurological outcome, complications, operative times, revision surgery rates, and estimated blood loss (EBL) were evaluated.

RESULTS

Thirty-four patients underwent transpedicular corpectomies, and 46 patients underwent anterior thoracolumbar approaches. Single-level transpedicular corpectomies appear to be comparable to anterior-only corpectomies in terms of EBL, operative time, and complication rates. There was a higher complication rate, increased EBL, and longer operative time with anterior-posterior corpectomies compared with transpedicular corpectomies. Patients undergoing transpedicular corpectomies had a greater recovery of neurological function than those in whom anterior-approach corpectomies were performed.

CONCLUSIONS

The transpedicular corpectomy appears to have a comparable morbidity rate to anterior-only corpectomies, but its morbidity rate is lower than that of anterior-posterior corpectomies.

摘要

目的

尽管标准的经前路胸腰椎椎体切除术已被广泛应用,但经椎弓根技术越来越多地被用于经后路进行椎体切除术。作者进行了一项研究,通过比较经椎弓根椎体切除术和标准的前路胸腰椎椎体切除术,分析其结果是否存在差异。

方法

高级作者于 2004 年至 2008 年间对 80 例患者进行了胸腰椎椎体切除术。作者回顾了病历和随访数据,包括就诊、影像学检查或电话访谈。评估了神经功能结果、并发症、手术时间、翻修手术率和估计失血量(EBL)。

结果

34 例患者接受了经椎弓根椎体切除术,46 例患者接受了前路胸腰椎手术。单节段经椎弓根椎体切除术在 EBL、手术时间和并发症发生率方面与前路椎体切除术相似。前路-后路椎体切除术的并发症发生率更高、EBL 增加和手术时间延长。与前路椎体切除术相比,接受经椎弓根椎体切除术的患者神经功能恢复更好。

结论

经椎弓根椎体切除术的发病率似乎与前路椎体切除术相当,但低于前路-后路椎体切除术。

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