Huntington C F, Murrell W D, Betz R R, Cole B A, Clements D H, Balsara R K
Center for Orthopaedics, Johnston, Rhode Island, USA.
Spine (Phila Pa 1976). 1998 Aug 1;23(15):1699-702. doi: 10.1097/00007632-199808010-00016.
The authors undertook a randomized comparison of 30 thoracoscopic and 30 open thoracic discectomies for anterior spinal fusion in a live sheep model.
To compare in a live sheep model discectomies performed using a thoracoscopic technique with those using an open thoracotomy technique to validate the efficacy of thoracoscopic disc and end plate removal for potential fusion.
In 1993, Mack and Regan described a technique for video-assisted thoracic surgery that resulted in less morbidity than open techniques. Subsequent reports support the finding that thoracoscopic spinal surgery results in less morbidity.
Sixty discectomies were performed in 10 live sheep. In each sheep, three randomly selected discectomies were performed thoracoscopically, and, subsequently, three open discectomies were performed. The animal then was killed, and the spine was sectioned and analyzed by computer imaging.
Statistical analysis found no significant difference in the amount of disc resected (t' = 1.9639, t0.025, 60 = 2.000, alpha = 0.05). The mean percentage of disc resected was 67.8% (range, 0-92.2%) in the thoracoscopic group and 76.1% (range, 44.9-95.4%) in the open group. More than 50% of the disc was excised in 27 of 30 spines (90%) in the thoracoscopic group and in 29 of 30 (96.7%) in the open group. This difference was not statistically significant (theta 2(0.05, 1) = 3.84, theta 2' = 1.07).
The findings in this study indicate that the thoracoscopic discectomy technique is equivalent to the open technique in the amount of disc and end plate resected. In addition, these findings suggest that thoracoscopic discectomies provide adequate disc resection to provide for an acceptable fusion rate according to the criteria demonstrated by Bunnell in 1982 and therefore support the efficacy of a thoracoscopic technique for anterior spinal fusion.
作者在活羊模型中对30例胸腔镜下和30例开放胸廓椎间盘切除术用于前路脊柱融合术进行了随机对照研究。
在活羊模型中比较胸腔镜技术与开放胸廓切开术技术进行的椎间盘切除术，以验证胸腔镜下椎间盘和终板切除对潜在融合的疗效。
1993年，Mack和Regan描述了一种电视辅助胸腔镜手术技术，该技术导致的发病率低于开放技术。随后的报告支持了胸腔镜脊柱手术导致发病率较低的这一发现。
在10只活羊身上进行了60例椎间盘切除术。在每只羊身上，随机选择三个椎间盘切除术通过胸腔镜进行，随后再进行三个开放椎间盘切除术。然后处死动物，将脊柱切片并通过计算机成像进行分析。
统计分析发现切除的椎间盘量无显著差异（t' = 1.9639，t0.025, 60 = 2.000，α = 0.05）。胸腔镜组切除椎间盘的平均百分比为67.8%（范围0 - 92.2%），开放组为76.1%（范围44.9 - 95.4%）。胸腔镜组30个脊柱中有27个（90%）切除了超过50%的椎间盘，开放组30个中有29个（96.7%）。这种差异无统计学意义（θ2(0.05, 1) = 3.84，θ2' = 1.07）。
本研究结果表明，胸腔镜下椎间盘切除术技术在切除椎间盘和终板的量方面与开放技术相当。此外，这些结果表明，根据Bunnell在1982年证明的标准，胸腔镜下椎间盘切除术能提供足够的椎间盘切除以实现可接受的融合率，因此支持胸腔镜技术用于前路脊柱融合术的疗效。
