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胸腔镜辅助下微创开放手术治疗胸段及胸腰段脊髓压迫症

Thoracic Endoscopic-Assisted Mini-Open Surgery for Thoracic and Thoracolumbar Spinal Cord Compression.

作者信息

Xu Bao-Shan, Xu Hai-Wei, Yuan Qiu-Ming, Liu Yue, Yang Qiang, Jiang Hong-Feng, Wang Dong-Bin, Ji Ning, Ma Xin-Long, Zhang Yang

机构信息

Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin, China.

Department of Thoracic Surgery, Tianjin Hospital, Tianjin, China.

出版信息

Orthop Surg. 2016 Nov;8(4):523-526. doi: 10.1111/os.12281.

Abstract

Intervertebral disc herniation is a common cause of spinal cord compression, especially for the thoracic and thoracolumbar spinal cord, which has limited buffer space in the spinal canal. Spinal cord compression usually causes decreased sensation and paralysis of limbs below the level of compression, urinary and fecal incontinence, and/or urinary retention, which brings great suffering to the patients and usually requires surgical intervention. Thoracotomy or abdominothoracic surgery is usually performed for the thoracolumbar cord compression caused by hard intervertebral disc herniation. However, there is high risk of trauma and complications with this surgery. To reduce the surgical trauma and obtain good visibility, we designed athoracic endoscopic-assisted mini-open surgery for thoracic and thoracolumbar disc herniation, and performed this procedure on 10 patients who suffered from hard thoracic or thoracolumbar spinal cord compression. During the procedure, the thoracic endoscopy provided clear vision of the surgical field with a good light source. The compression could be fully exposed and completely removed, and no nerve root injury or spinal cord damage occurred. All patients achieved obvious recovery of neurological function after this procedure. This technique possesses the merits of minimal trauma, increased safety, and good clinical results. The aim of this study is to introduce this thoracic endoscopic-assisted mini-open surgery technique, and we believe that this technique will be a good choice for the thoracic and thoracolumbar cord compression caused by hard intervertebral disc herniation.

摘要

椎间盘突出是脊髓压迫的常见原因,特别是对于胸段和胸腰段脊髓,其在椎管内的缓冲空间有限。脊髓压迫通常会导致压迫平面以下肢体感觉减退和瘫痪、大小便失禁和/或尿潴留,给患者带来极大痛苦,通常需要手术干预。对于因坚硬椎间盘突出导致的胸腰段脊髓压迫,通常采用开胸手术或胸腹联合手术。然而,这种手术创伤大且并发症风险高。为了减少手术创伤并获得良好的视野,我们设计了一种用于胸段和胸腰段椎间盘突出症的胸腔镜辅助小切口手术,并对10例患有坚硬胸段或胸腰段脊髓压迫的患者进行了该手术。在手术过程中,胸腔镜在良好的光源下提供了清晰的手术视野。压迫部位能够充分暴露并完全解除,未发生神经根损伤或脊髓损伤。所有患者术后神经功能均明显恢复。该技术具有创伤小、安全性高和临床效果好的优点。本研究的目的是介绍这种胸腔镜辅助小切口手术技术,我们相信该技术将是治疗因坚硬椎间盘突出导致的胸段和胸腰段脊髓压迫的一个良好选择。

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