文档介绍：CHAPTER 13
THORACOSCOPIC-ASSISTED TREATMENT OF THORACIC AND
LUMBAR FRACTURES:ASERIES OF 371 CONSECUTIVE
CASES
Larry T. Khoo, . OBJECTIVE: Conventional approaches for the treatment of thoracic and thoracolumbar
Comprehensive Spine Center, fractures require extensive surgical exposure, often leading to significant postoperative
Division of Neurosurgery, pain and morbidity. Thoracoscopic spinal surgery was performed to reduce the mor-
University of California at Los
Angeles, Los Angeles, California bidity of these approaches while still achieving the primary goals of spinal pres-
sion, reconstruction, and stabilization.
Rudolf Beisse, . METHODS: Between May 1996 and May 2001, 371 patients with fractures of the
Berufs-genossenschaftliche thoracic and thoracolumbar spine (T3–L3) were treated with a thoracoscopically as-
Unfallklinik Murnau, Murnau, sisted procedure. In the first 197 patients, a conventional open anterior plating system
Germany
was used. The last 174 patients were treated with the MACS-TL system (Aesculap,
Michael Potulski, Tuttlingen, Germany), which was designed specifically for endoscopic placement,
Berufs-genossenschaftliche thereby significantly reducing operative times.
Unfallklinik Murnau, Murnau, RESULTS: Seventy-three percent of the fractures were located at the thoracolumbar
Germany junction. In 49% of patients, mobilization of the diaphragm was performed to expose
the fracture, with later repair. Both x-ray promise and neural deficit were
Reprint requests:
Rudolf Beisse, ., Berufs- present in 15% of patients. In 35% of patients, a stand-alone anterior thoracoscopic
genossenschaftliche Unfallklinik reconstruction was performed. In 65% of patients, a supplemental posterior pedicle-
Murnau, Prof.-Küntscher-Straße 8, screw construct was also placed either before or after the anterior construct. A steep
82418 Murnau, Germany.
Email: learning curve was present, with an average operating time of 300 minutes