1Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana; and.
2Department of Neurological Surgery, University of California, San Francisco, California.
Neurosurg Focus. 2020 Sep;49(3):E12. doi: 10.3171/2020.6.FOCUS20366.
OBJECTIVE: The need for anterior column reconstruction after thoracolumbar burst fractures remains controversial. Here, the authors present their experience with minimally invasive lateral thoracolumbar corpectomies for traumatic fractures. METHODS: Between 2012 and 2019, 59 patients with 65 thoracolumbar fractures underwent 65 minimally invasive lateral corpectomies (MIS group). This group was compared to 16 patients with single-level thoracolumbar fractures who had undergone open lateral corpectomies with the assistance of general surgery between 2007 and 2011 (open control group). Comparisons of the two groups were made with regard to operative time, estimated blood loss, time to ambulation, and fusion rates at 1 year postoperatively. The authors further analyzed the MIS group with regard to injury mechanism, fracture characteristics, neurological outcome, and complications. RESULTS: Patients in the MIS group had a significantly shorter mean operative time (228.3 ± 27.9 vs 255.6 ± 34.1 minutes, p = 0.001) and significantly shorter mean time to ambulation after surgery (1.8 ± 1.1 vs 5.0 ± 0.8 days, p < 0.001) than the open corpectomy group. Mean estimated blood loss did not differ significantly between the two groups, though the MIS group did trend toward a lower mean blood loss. There was no significant difference in fusion status at 1 year between the MIS and open groups; however, this comparison was limited by poor follow-up, with only 32 of 59 patients (54.2%) in the MIS group and 8 of 16 (50%) in the open group having available imaging at 1 year. Complications in the MIS group included 1 screw misplacement requiring revision, 2 postoperative femoral neuropathies (one of which improved), 1 return to surgery for inadequate posterior decompression, 4 pneumothoraces requiring chest tube placement, and 1 posterior wound infection. The rate of revision surgery for the failure of fusion in the MIS group was 1.7% (1 of 59 patients). CONCLUSIONS: The minimally invasive lateral thoracolumbar corpectomy approach for traumatic fractures appears to be relatively safe and may result in shorter operative times and quicker mobilization as compared to those with open techniques. This should be considered as a treatment option for thoracolumbar spine fractures.
目的:胸腰椎爆裂骨折后是否需要重建前柱仍存在争议。本文作者介绍了他们在微创侧前路胸腰椎体切除术治疗创伤性骨折方面的经验。
方法:2012 年至 2019 年,59 例 65 个胸腰椎骨折患者接受了 65 例微创侧前路胸腰椎体切除术(微创组)。将该组与 2007 年至 2011 年接受开放侧前路胸腰椎体切除术的 16 例单节段胸腰椎骨折患者(开放对照组)进行比较。比较两组的手术时间、估计失血量、下床活动时间和术后 1 年的融合率。作者还进一步分析了微创组的损伤机制、骨折特征、神经功能结果和并发症。
结果:微创组的平均手术时间(228.3 ± 27.9 分钟比 255.6 ± 34.1 分钟,p = 0.001)和术后下床活动时间(1.8 ± 1.1 天比 5.0 ± 0.8 天,p < 0.001)明显短于开放组。两组的平均估计失血量无显著差异,但微创组的失血量有下降趋势。术后 1 年时,微创组和开放组的融合状态无显著差异;然而,由于随访不良,仅有 59 例患者中的 32 例(54.2%)和 16 例开放组中的 8 例(50%)在术后 1 年时具有可用的影像学资料。微创组的并发症包括 1 例螺钉位置不当需要翻修、2 例术后股神经病变(其中 1 例改善)、1 例因后减压不足再次手术、4 例需要放置胸腔引流管的气胸和 1 例后路伤口感染。微创组融合失败的翻修手术率为 1.7%(59 例患者中有 1 例)。
结论:微创侧前路胸腰椎体切除术治疗创伤性骨折相对安全,与开放技术相比,手术时间可能更短,下床活动更快。这应该被视为胸腰椎骨折的一种治疗选择。
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