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Thorakolumbale Frakturen

Minimalinvasive ventrale Stabilisierung

Thoracolumbar fractures

Minimally invasive anterior stabilization

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Der Artikel stellt den aktuellen Stand des Wissens zur minimalinvasiven ventralen Stabilisierung von thorakolumbalen Frakturen dar. Prinzipiell sind alle Bereiche der Brust- (BWS) und Lendenwirbelsäule (LWS) minimalinvasiv oder rein endoskopisch zu erreichen. Die Ergebnisse entsprechen denen der offenen Verfahren. Bewährt haben sich v. a. thorakoskopische oder thorakoskopisch assistierte Zugänge für den Bereich BWK4–LWK2 (BWK: Brust-, LWK: Lendenwirbelkörper). Eine Zwerchfellschlitzung ist meist ab BWK12 nötig. Für den Zugang zur LWS sind minimalinvasive retroperitoneale Zugänge geeignet. Laparoskopische und retroperitoneoskopische Zugänge zeigten dagegen keine Vorteile. Minimalinvasive Zugänge reduzieren zwar die postoperativen Beschwerden und verbessern das kosmetische Ergebnis, zu einer signifikanten Senkung der Komplikationsrate führten sie bisher jedoch nicht. Die minimalinvasive Stabilisierung von Frakturen der BWS und LWS ist sicher und effektiv. Rein endoskopische Techniken bieten keinen Vorteil gegenüber den endoskopisch assistierten Zugängen.

Abstract

The article outlines the current knowledge about minimally invasive anterior surgery for stabilization of thoracolumbar fractures. With the use of minimally invasive or endoscopic techniques, all areas of the thoracolumbar spine can be addressed surgically with outcomes comparable to those with standard open procedures. Thoracoscopic and thoracoscopic-assisted surgery are well-proven methods for treating the spine from T4 to L2. Typically, an incision of the diaphragm is necessary to reach the spine below T12. Additionally, the lumbar spine can be reached using minimally invasive retroperitoneal approaches. Laparoscopic and retroperitoneoscopic approaches have shown no advantages. Minimally invasive surgery reduces postoperative pain and improves cosmetic results compared with open procedures; however, the total complication rate has not been significantly reduced so far. Minimally invasive anterior stabilization of thoracolumbar fractures is safe and effective. Full endoscopic techniques have no advantages compared with endoscopic-assisted approaches.

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Correspondence to K.J. Schnake.

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Schnake, K., Kandziora, F. & Hoffmann, R. Thorakolumbale Frakturen. Trauma Berufskrankh 11, 87–93 (2009). https://doi.org/10.1007/s10039-009-1490-5

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  • DOI: https://doi.org/10.1007/s10039-009-1490-5

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