骨科領域之微創手術簡介

Minimally Invasive Surgeries in Orthopedics

傳統的骨科手術都需在較大的傷口下才能完成，不但增加手術出血的風險，且造成廣泛組織傷害，損壞局部血液供應，減緩組織癒合速度，增加局部血腫、感染和骨折不癒合的風險，結果會影響病患復原的速度和臨床療效。此情形在骨科的所有次專科領域情形都相似。有鑑於此，許多醫工科學家和醫師專家投入心力於改良骨科影像診斷科技、手術技術、手術儀器及工具、骨科醫療器材等，推出許多新一代手術儀器和技術，配合慎選合適的治療對象，讓許多往昔需要大費周章的骨科手術，目前已可由微創手術取代完成。許多文獻評估顯示微創手術的許多優點，包括傷口小而較美觀、組織傷害小、減少出血量和輸血的相關併發症、術後疼痛減輕、住院時間縮短、功能復原增快，和較早恢復工作。目前骨科界的微創手術發展蓬勃，蔚為風潮。骨科領域的微創手術種類很多，在骨科的各次專科領域都開發出許多新式手術式，包括脊椎手術、骨折手術、人工關節置換、關節鏡手術、小兒骨科手術、手外科手術、足踝骨科手術、肩肘關節手術、骨腫瘤手術等，都各搭配許多嶄新微創手術式、醫材和工具。由於骨骼肌肉系統的解剖學具有其特色，且各種微創手術的器具各具特色而有很大差異，因此執行骨科微創手術的醫師，必須嫻熟各手術部位的解剖，並熟稔手術器具應用和術式，才能安全地施行成功微創手術。但是微創手術也有其限制，並非所有骨科疾病都可採用，在治療前應注意慎選合適的對象和適應症，並考量技術層面的成熟度，才會發揮最大的功效。

Traditional orthopaedic operations need a large wound to complete the procedure. Thus it will increase the risks of hemorrhage, cause extensive tissue damage, impair the local blood supply, thus increase the risks of local heamatoma, infection and nonunion of fracture, etc. The recovery of patient and clinical outcomes will be compromised. This situation is similar in all subspeciality fields of Orthopaedics. Therefore, many medical engineering scientists and medical experts devoted themselves to improving image diagnosis technologies, surgical techniques, surgical instruments and tools, new orthopaedic medical devices, etc. Using these new era design of surgical instruments and techniques, nowadays minimally invasive surgeries (MIS) take place of many traditional complicated orthrpaedic surgeries in properly selected patients. The evaluation reports in the literature showed that using this approach has several advantages, including smaller and better cosmetic wounds, minimal soft tissue disruption, minimal blood loss and blood transfusion-related complications, decreasing post-operative pain, shorter hospital stay, faster functional recovery, and early return to work. Currently MIS in orthoapedics expands rapidly and is all the rage recently. There are many kinds of MIS in the orthopaedics fields. Many new innovative surgical procedures have been developed in every subspeciality field of orthopaedics, including spine surgeries, fracture operations, total joint replacements, arthroscopies, as well as surgeries in pediatric orthopaedic, hand, ankle and foot, shoulder and elbow, as well as orthopaedic oncology field, etc. All these procedures have their own new MIS procedures, medical devices and instruments. With regards to the characteristics of musculoskeletal anatomy and MIS surgical instruments, the orthopaedics MIS surgeons need to be familiar with regional anatomy of the surgical sites in addition to proper usage of instruments and procedures before a successful MIS can be safely performed. However, MIS has its own limitations. MIS can not be applied to all orthopaedic diseases. We need to carefully select proper patients and indications, in addition to the maturation of surgical skills, to ensure the maximal effects of MIS.