胸腰段脊柱骨折前路减压与内固定术的技术改进.docVIP

胸腰段脊柱骨折前路减压与内固定术的技术改进 目录 TOC \o "1-9" \h \z \u 目录 1 正文 1 文1：胸腰段脊柱骨折前路减压与内固定术的技术改进 1 1 资料与方法 2 2 结果 3 3 讨论 4 文2：AF内固定系统治疗胸腰段脊柱骨折合并脊髓损伤 6 1 资料与方法 7 2 结果 8 3 讨论 8 参考文摘引言： 10 原创性声明（模板） 11 文章致谢（模板） 11 正文 胸腰段脊柱骨折前路减压与内固定术的技术改进 文1：胸腰段脊柱骨折前路减压与内固定术的技术改进 【Abstract】 Objective To investigate the operative technique improvement in order to reduce heavy trauma, long time and much blood loss by anterior approach to the thoracolumbar spine. Methods An exposure via the twelfth rib extrapleural and retroperitoneal was used, retenting of the twelfth rib at L1 fracture; only dealing with artery of the injured vertebra; adjusting the screw position and improving the operation procedure, at the same time the deliberate hypoteion was performed. At least two modified techniques in four were applied on each patient. Results All of the 25 cases were operated successfully by modified techniques. The operation time was 110～150 minutes(average 130minutes), the blood loss was 350～900ml(average 550ml), the incision length was 12～20cm(average 15cm). Abdominal aorta ruptured in 1 patient and pleura injured in 2 during operation. All cases were followed up, the average follow-up was months with a range from 3 to 50 months. The spinal canals were enlarged obviously, no patient had neurological deterioration, 1 case was found hardware loosening combined with kyphosis deformity. The ASIA Scale changed as follows: 3 cases of scale A(3A) changed to 2A, 1B; B in 4 before operation and changed to 1B,1C,2D; 14C to 1C,3D,10E; 4D to 4E. Conclusion The technical improvements have the advantages of minor trauma, less blood loss and shorter operation time. It will help docto choose anterior approach for the thoracolumbar but fractures. 【Key words】Anterior decompression Thoracolumbar spine Fracture Internal fixation Technical improvement 合并神经损伤和压迫的胸腰段脊柱爆裂骨折采用前方减压较为适宜［１］。但前路手术创伤大，出血多，操作难度高及手术时间长。自2001年3月起，本科对胸腰段前路手术显露技巧，腰动静脉血管处理，螺钉固定位置和操作程序等进行了细致的研究和改进，取得了较好的临床效果，现报告如下。 1 资料