Newton P O, Cardelia J M, Farnsworth C L, Baker K J, Bronson D G
University of California San Diego, Department of Orthopedic Surgery, USA.
Spine (Phila Pa 1976). 1998 Mar 1;23(5):530-5; discussion 536. doi: 10.1097/00007632-199803010-00003.
A biomechanical assessment of anterior release and discectomy in the thoracic spine was performed on an animal model using thoracoscopic and open thoracotomy techniques.
To compare the relative efficacy of these two techniques of release in achieving increased spinal mobility.
The clinical use of video-assisted thoracoscopy in the correction of spinal deformity is increasing. The effectiveness of thoracoscopic anterior spinal release with discectomy has not been evaluated biomechanically.
Anterior release with discectomy was performed on six midthoracic motion segments in five mature goats. The thoracoscopic technique was used for three levels on one side, and an open thoracotomy was used for the alternating three levels of the contralateral side. The duration of surgery for disc excision and the amount of blood loss for each technique were recorded. The intact cranial and caudal motion segments served as controls. The motion segments were individually subjected to nondestructive biomechanical testing. Torsional, sagittal, and coronal bending torques were applied, and the resulting angular displacement was measured.
The duration of surgery to remove a disc thoracoscopically decreased as experience was gained by the surgeon. The amount of intraoperative blood loss was comparable using the two methods. There was significantly increased flexibility in the released segments with both techniques, compared with the flexibility in the intact levels for all three loading directions. There was no difference in the motion obtained after release between the two techniques.
Open and thoracoscopic anterior release and discectomy have been demonstrated, through biomechanical in vitro testing, to increase the flexibility of the spine to a similar extent.
在动物模型上，采用胸腔镜和开放胸廓切开术技术，对胸椎前路松解和椎间盘切除术进行生物力学评估。
比较这两种松解技术在增加脊柱活动度方面的相对疗效。
电视辅助胸腔镜在脊柱畸形矫正中的临床应用正在增加。胸腔镜下前路脊柱松解并椎间盘切除术的有效性尚未进行生物力学评估。
对5只成年山羊的6个胸段中部运动节段进行前路松解并椎间盘切除术。胸腔镜技术用于一侧的3个节段，对侧交替的3个节段采用开放胸廓切开术。记录每种技术的椎间盘切除手术时间和失血量。完整的头侧和尾侧运动节段作为对照。对运动节段分别进行无损生物力学测试。施加扭转、矢状面和冠状面弯曲扭矩，并测量由此产生的角位移。
随着外科医生经验的增加，胸腔镜下椎间盘切除的手术时间缩短。两种方法的术中失血量相当。与所有三个加载方向的完整节段相比，两种技术在松解节段的灵活性均显著增加。两种技术松解后获得的运动没有差异。
通过体外生物力学测试表明，开放和胸腔镜下前路松解和椎间盘切除术在增加脊柱灵活性方面程度相似。
