47. 微创俯卧胸膜后外侧胸膜后外侧胸膜外侧切除术与卧位胸膜后外侧胸膜外侧切除术：临床结果的比较分析

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100741

Yu-Cheng Yeh MD , Hsuan Lun Yang MD , Yung Hsueh Hu MD

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引用次数: 0

摘要

背景：卧位外侧经胸膜入路传统上用于治疗胸椎前柱病变。然而，对于复杂的病理，通常需要重新定位后路内固定。最近，微创俯卧侧位脊柱手术被引入，允许同时操作前后柱，避免重新悬垂并改善前凸对齐。与经胸膜入路相比，微创胸膜后入路因其避免了侵犯胸膜、横膈膜取下和单肺通气，从而减少了术后胸腔积液、肺炎等并发症而得到了广泛的应用。目的通过两种微创技术的结合，评价俯卧位胸膜后外侧胸膜后椎体切除术的可行性，并与常规卧位胸膜后外侧椎体切除术的肺部并发症及手术效果进行比较。研究设计/设置：回顾性研究。患者样本：从2016年到2023年，我们回顾性分析了同一天因各种胸椎病变接受胸外侧椎体切除术和后路内固定的患者。没有术后1年随访或接受外侧椎体切除术而没有后路内固定的患者被排除在外。记录并分析临床结果、胸后凸矫正和术后肺部并发症。方法将患者分为俯卧位胸膜后外侧椎体切除术（RP）组（27例）和常规卧位胸膜后外侧椎体切除术（TP）组（54例）。比较两组的结局指标。结果两组患者在年龄、性别、体重指数、Charlson合并症指数、病因等方面无显著差异。手术长度也具有可比性（RP: 5.4±2.0 vs TP: 5.5±2.1,p = 0.97），但RP组的椎体切除水平明显较短(1.1±0.3 vs 1.5±0.7,p <；0.001)。RP组胸后凸矫正量大于TP组（21.0°±16.5°vs 8.8°±11.4°，p = 0.002）。术后肺部并发症方面，RP组CP角钝化发生率较低（44.4% vs 74.1%, p = 0.009），肺炎需要抗生素（0% vs 18.5%, p = 0.026）。此外，RP组胸腔引流持续时间明显缩短（4.1±2.9 vs 6.4±4.1天，p = 0.015），住院时间缩短(21.2±16.5 vs 38.2±24.5天，p <；0.001)。结论：与卧位胸膜侧位胸膜后椎体切除术相比，微创俯卧侧位胸膜后椎体切除术是一种安全可行的胸椎病变治疗方法，可提供更好的后凸矫正，肺部并发症少，住院时间短。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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47. Minimally invasive prone lateral retropleural corpectomy vs decubitus lateral transpleural corpectomy: a comparative analysis of clinical outcomes

BACKGROUND CONTEXT

Decubitus lateral transpleural approach has been traditionally applied for tackling thoracic spinal pathologies at the anterior column. However, reposition for posterior instrumentation was often needed for complex pathologies. Recently, minimally invasive prone lateral single-position spinal surgery was introduced to allow simultaneous manipulation of the anterior and posterior columns, avoiding re-draping and improving lordotic alignment. Compared with transpleural approach, minimally invasive retropleural approach has gained popularity as it avoids pleural invasion, diaphragm takedown and one-lung ventilation, thereby reducing postoperative complications like pleural effusion and pneumonia.

PURPOSE

By combining these two minimally invasive techniques, this study aims to evaluate the feasibility of prone lateral retropleural corpectomy and compares its pulmonary complications and surgical outcomes with the conventional decubitus lateral transpleural corpectomy.

STUDY DESIGN/SETTING

Retrospective study.

PATIENT SAMPLE

From 2016 to 2023, we retrospectively reviewed patients who underwent lateral thoracic corpectomy and posterior instrumentation on the same day for various thoracic spinal pathologies. Those without a postoperative 1-year follow-up or received lateral corpectomy without posterior instrumentation were excluded.

OUTCOME MEASURES

Clinical outcomes, thoracic kyphosis correction, and postoperative pulmonary complications were recorded and analyzed.

METHODS

The patients were divided into prone lateral retropleural corpectomy (RP) group (N=27) and conventional decubitus lateral transpleural corpectomy (TP) group (N=54). The outcome measures were compared between the two groups.

RESULTS

There were no significant differences in terms of age, sex, body mass index, Charlson comorbidity index, or etiologies between the two groups. The surgical lengths were also comparable (RP: 5.4 ± 2.0 vs TP: 5.5 ± 2.1, p = 0.97), but the RP group has significantly shorter corpectomy level (1.1 ± 0.3 vs 1.5 ± 0.7, p < 0.001). The thoracic kyphosis correction was greater in the RP group than in the TP group (21.0° ± 16.5° vs 8.8° ± 11.4°, p = 0.002). Regarding postoperative pulmonary complications, the RP group revealed a lower incidence of CP angle blunting (44.4% vs 74.1%, p = 0.009) and pneumonia requiring antibiotics (0% vs 18.5%, p = 0.026). Additionally, thoracic drainage duration was significantly shorter in the RP group (4.1 ± 2.9 vs 6.4 ± 4.1 days, p = 0.015), as well as a reduced hospital stay (21.2 ± 16.5 vs 38.2 ± 24.5 days, p < 0.001).

CONCLUSIONS

Minimally invasive prone lateral retropleural corpectomy is a safe and feasible alternative for thoracic spinal pathologies, providing superior kyphosis correction, fewer pulmonary complications, and shorter hospital stays compared to decubitus lateral transpleural corpectomy.