Gonschorek O, Spiegl U, Weiss T, Pätzold R, Hauck S, Bühren V
Wirbelsäulenchirurgie, Berufsgenossenschaftliche Unfallklinik, Prof.-Küntscher-Straße 8, Murnau, Germany.
Unfallchirurg. 2011 Jan;114(1):26-34. doi: 10.1007/s00113-010-1940-3.
The morbidity of anterior approaches has significantly influenced the development of therapeutic concepts for the treatment of thoracolumbar spine fractures. Minimally-invasive techniques such as mini-open and endoscopic have enlarged the numbers of anterior reconstruction after spinal fractures in the thoracolumbar region. These minimally-invasive approaches have been facilitated by the development of special implants adapted to the new technique and to the local anatomical requirements.Two multi center studies in Germany (MCSI and II) showed the trend towards minimal invasive procedures and anterior approaches in the German speaking spine centers. Since the first report on thoracoscopic anterior procedures in Germany in 1997 a growing number of spine centers established this method. There is still no evidence based high level literature to substantiate a significant benefit for the patients by anatomical reduction and reconstruction of the anterior spinal column. However, there are some reports on better short outcomes in radiological parameters as well as better clinical results in 5 to 8 year follow-ups.The minimal invasive anterior approach seems to be advantageous for the patients by reducing significantly additive operation morbidity. It has become more important over the last two decades for anterior reconstruction after trauma and posttraumatic malalignment of the thoracolumbar spine.
前路手术的发病率显著影响了胸腰椎骨折治疗理念的发展。诸如迷你开放手术和内窥镜手术等微创技术增加了胸腰椎区域脊柱骨折后前路重建的数量。适应新技术和局部解剖学要求的特殊植入物的开发推动了这些微创方法的应用。德国的两项多中心研究（MCSI和II）显示，在德语区脊柱中心有采用微创和前路手术的趋势。自1997年德国首次报道胸腔镜前路手术以来，越来越多的脊柱中心采用了这种方法。目前仍没有基于证据的高水平文献来证实通过前路脊柱解剖复位和重建对患者有显著益处。然而，有一些报告显示在放射学参数方面短期效果较好，以及在5至8年随访中临床结果较好。微创前路手术似乎通过显著降低额外手术发病率对患者有利。在过去二十年中，它对于胸腰椎创伤后前路重建和创伤后畸形矫正变得更加重要。
