后路经皮双侧椎弓根入路 360°固定治疗高危患者
360-degree osteosynthesis via a posterolateral transpedicular approach in high-risk patients.
机构信息
Department of Neurosurgery, Heinrich-Heine-University, Moorenstraße 5, Düsseldorf, Germany.
出版信息
Eur Spine J. 2012 Jun;21(6):1207-13. doi: 10.1007/s00586-012-2150-1. Epub 2012 Jan 11.
PURPOSE
Patients requiring anterior-posterior thoracic spine stabilization and suffering from concomitant cardiopulmonary disease are at increased risk to develop procedure-related complications. In order to reduce cardiopulmonary complications, the efficacy of a posterolateral transpedicular approach for 360-degree fusion was investigated.
METHODS
Fourteen consecutive patients presenting with spinal cord compression from osteoporotic, metastatic and tuberculotic fractures were treated. Spinal cord decompression was achieved by laminectomy, facetectomy and corpectomy with subsequent posterior instrumented fusion using a screw-rod system.
RESULTS
The procedure was successfully performed in 14 high-risk patients. Preoperatively, all patients presented with thoracic and lower back pain and nine patients with a paraparesis (Frankel grade C). The implants were introduced monoportally or biportally. In all cases, neurological symptoms moderately improved.
CONCLUSION
The posterolateral transpedicular approach might be a safe, less-invasive and efficient alternative to anterior-posterior fusion. However, biomechanic efficacy and long-term outcome as compared to the transthoracic technique remains to be studied in a larger patient cohort.
目的
需要前后胸脊柱稳定并伴有心肺疾病的患者发生与手术相关的并发症的风险增加。为了减少心肺并发症，研究了后路经椎弓根入路进行 360 度融合的疗效。
方法
连续收治了 14 例因骨质疏松性、转移性和结核性骨折导致脊髓压迫的患者。通过椎板切除术、关节突切除术和椎体切除术进行脊髓减压，随后使用螺钉棒系统进行后路器械融合。
结果
14 例高危患者成功完成了手术。术前所有患者均有胸背部疼痛，9 例患者有截瘫（Frankel 分级 C）。植入物单端口或双端口引入。在所有情况下，神经症状均有一定程度的改善。
结论
后路经椎弓根入路可能是一种安全、微创、有效的前路融合替代方法。然而，与经胸技术相比，其生物力学疗效和长期结果仍需在更大的患者队列中进行研究。
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