RESUMO
Objective To investigate the clinical effects of surgical treatment of lower lumbar fracture with mini-incision via retroperitoneal anterior approach. Methods The data of 21 cases with serious lower lumbar burst fracture were analyzed retrospectively. There were 15 males and 6 females with an average age of 35.9 years (ranged, 19-65 years). The lesion was located in L3 in 10 cases, L4 in 8 and L5 in 3cases. According to Magerl classification, there was type A (burst in 12 cases, type B (distraction) in 2 and type C (retortion) in 7 cases. All the 21 cases were treated with anterior decompression, bone graft fusion and internal fixation with mini-incision via retroperitoneal anterior approach. The changes of radiograph and neurologic status were recorded respectively. Results All the cases had been followed up for an average of 41.9 months (12-86 months). The radiograph showed obvious improvement on the injured body height (from 42.62％ preoperatively to 94.33％ postoperatively, P＜0.01) and the canal encroachment index (from 2.67 preoperatively to 0.14 postoperatively, P＜0.01). Significant improvement in neurological function were achieved in all patients with the improvement of one grade except for 1 case with L3, T11 fracture and complete paraplegia. No failure of implants was found during the follow-up period. Conclusion Anterior decompression and internal fixation with mini-incision via retroperitoneal anterior approach are successful in treating serious lower lumbar burst fractures.
RESUMO
Objective To explore the feasibility and clinical effect of the video-assisted thoracoscopic surgery transdiaphragmatic approach in the management of thoracolumbar burst fractures. Methods 22 patients with thoracolumbar burst fractures were managed by the video-assisted thoracoscopic surgery transdiaphragmatic approach from September 2002 to September 2004. There were 15 males and 7 females, and the age of the patients were from 28 to 71 years with an average of 39 years. The fracture located at T11 in 2, T12 in 10 and L1 in 10. The states of preoperative neurological function were complete paraplegia in 7 cases and incomplete paraplegia in 15 cases. All cases were treated with anterior decompression, autograft and internal fixation with anterior plate fixation systems. Results The average operation time was 230 mins (180 to 320 mins). The average blood loss was 900 ml (500 to 2000 ml). An average followed up period was 19.5 months (9 to 35 months) in all patients. The fracture fragments were cleaned thoroughly and the vertebral canal were decompressed entirely showing on CT films. All patients had successful fusion with an average of 3.8 months. One fixing screw was penetrated into intervertebral space in 1 case. It had been recorrected under a fluoroscopic machine. One case was complicated leakage of cerebrospinal fluid and cured after one week in a prone position. No pleural effusion, pneumothorax and diaphragmatic herniations encountered. 4 cases with complete paraplegia didn't show any improvement, 14 cases had improved obviously in the function of the spinal cord. Conclusion The video-assisted thoracoscopic surgery transdiaphragmatic approach in the management of thoracolumbar burst fractures was feasible, for satisfactory vertebral canal decompression, graft and internal fixation. Diaphragmatic opening and repair can be accomplished safely and effectively without special endoscopic instrumentation. It also precludes the need for retropleural-retroperitoneal and open thoracoabdominal approaches and thus avoids the associated significant morbidity.