Treatment of thoracolumbar burst fractures with video-assisted thoracoscopic surgery transdiaphragmatic approach / 中华骨科杂志

ABSTRACT

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.