Cunningham B W, Kotani Y, McNulty P S, Cappuccino A, Kanayama M, Fedder I L, McAfee P C
Union Memorial Hospital Orthopaedic Biomechanics Laboratory, Baltimore, MD, USA.
Spine (Phila Pa 1976). 1998 Jun 15;23(12):1333-40. doi: 10.1097/00007632-199806150-00008.
In this in vivo investigation, a sheep model was used to compare the efficacy of a video-assisted thoracoscopic approach and a traditional thoracotomy in promoting a successful interbody spinal arthrodesis.
To compare the incidence of successful anterior spinal arthrodesis among three stabilization techniques-iliac crest, Bagby and Kuslich device, and Z-plate--performed using a video-assisted thoracoscopic approach and conventional open thoracotomy approaches.
A clinical outcome study on open versus endoscopic spinal fusion is not yet available. Moreover, no basic scientific investigations have been conducted to determine whether the success of an endoscopic arthrodesis is comparable to that of a conventional open procedure.
Fourteen Western Crossbred sheep underwent three identical destabilization procedures at T5-T6, T7-T8, and T9-T10, in which the anterior and middle osteoligamentous columns of the spine were resected, followed by three randomized reconstruction procedures using iliac autograft alone, and Z-plate stabilization with iliac autograft. In seven sheep, the entire destabilization-reconstruction procedure was performed using a video-assisted thoracoscopic surgical approach. In the remaining seven, the procedure was performed by conventional open thoracotomy.
Histomorphometric and biomechanical evaluation demonstrated that the video-assisted thoracoscopic approach and open thoracotomy arthrodesis had comparable bone formation and biomechanical properties (P > 0.05). However, the Z-plate fusions, as a group, demonstrated increased flexion-extension stiffness properties and trabecular bone formation compared with the autograft and Bagby and Kuslich device fusions (P < 0.05).
Thoracic interbody spinal fusions performed by thoracoscopy have demonstrated histologic, biomechanical, and radiographic equivalence to those performed by a thoracotomy approach. However, in the endoscopy group, intraoperative complications causing longer operative times, higher estimated blood loss, and increased animal morbidity indicated a substantial learning curve associated with the adoption of this surgical technique.
在这项体内研究中，使用绵羊模型比较电视辅助胸腔镜手术方法和传统开胸手术在促进成功的椎间脊柱融合方面的疗效。
比较使用电视辅助胸腔镜手术方法和传统开胸手术方法进行的三种稳定技术（髂嵴、Bagby和Kuslich装置以及Z形钢板）中成功的前路脊柱融合的发生率。
尚无关于开放与内镜下脊柱融合的临床结果研究。此外，尚未进行基础科学研究来确定内镜下融合的成功率是否与传统开放手术相当。
14只西部杂交绵羊在T5-T6、T7-T8和T9-T10处接受了三次相同的去稳定化手术，其中切除脊柱的前和中骨韧带柱，随后进行三次随机重建手术，分别单独使用髂骨自体移植、使用髂骨自体移植的Z形钢板稳定术。7只绵羊使用电视辅助胸腔镜手术方法进行整个去稳定化-重建手术。其余7只通过传统开胸手术进行该手术。
组织形态计量学和生物力学评估表明，电视辅助胸腔镜手术方法和开胸手术融合在骨形成和生物力学特性方面具有可比性（P>0.05）。然而，作为一组，Z形钢板融合与自体移植以及Bagby和Kuslich装置融合相比，在屈伸刚度特性和小梁骨形成方面有所增加（P<0.05）。
胸腔镜下进行的胸椎椎间融合在组织学、生物力学和影像学方面已证明与开胸手术方法相当。然而，在内镜组中，导致手术时间延长、估计失血量增加和动物发病率增加的术中并发症表明采用这种手术技术存在相当大的学习曲线。
