Barone G W, Eidt J F, Webb J W, Hudec W A, Pait T G
Department of Surgery, University of Arkansas for Medical Sciences, Little Rock 72205, USA.
Am Surg. 1998 Apr;64(4):372-5.
General surgeons often provide the exposure for the anterior repair of vertebral body lesions. The standard anterior approach to the thoracolumbar junction (T11-L1) is a transpleural 9th or 10th rib thoracoabdominal incision. From October 1995 through March 1997, 22 patients underwent anterior repair of thoracolumbar junction vertebral lesions through an alternative 11th rib resection while maintaining an extrapleural approach. Exposure was excellent, as judged by the neurosurgical team completing the repairs. Chest tubes were not used routinely, and all patients healed without complications. A major limitation of the 11th rib extrapleural approach to the thoracolumbar junction has been poor exposure. This problem is eliminated with the use of an abdominal self-retaining retractor system. With many potential advantages to this 11th rib exposure (less pain, fewer pulmonary problems, and better wound healing), we consider the 11th rib incision to be the approach of choice to the thoracolumbar junction and recommend renewed interest in this incision.
普通外科医生常为椎体病变的前路修复提供手术显露。胸腰段交界处（T11-L1）的标准前路手术入路是经第9或第10肋的经胸腹膜外胸腹联合切口。从1995年10月至1997年3月，22例患者通过另一种第11肋切除并维持胸膜外入路的方式接受了胸腰段交界处椎体病变的前路修复。据完成修复的神经外科团队判断，显露效果极佳。未常规使用胸管，所有患者均顺利愈合且无并发症。第11肋胸膜外入路至胸腰段交界处的一个主要局限性是显露不佳。使用腹部自固定牵开器系统可消除这一问题。鉴于这种第11肋显露方式有许多潜在优势（疼痛减轻、肺部问题减少以及伤口愈合更好），我们认为第11肋切口是胸腰段交界处的首选入路，并建议重新关注这一切口。
