特发性胸椎侧凸胸腔镜下前路矫形与开放小切口前路矫形的疗效比较

Thoracoscopic and mini-open thoracotomic anterior correction for idiopathic thoracic scoliosis: a comparison of their clinical results

目的对特发性胸椎侧凸胸腔镜下前路矫形与开放小切口前路矫形的近期疗效进行比较。方法将23例特发性胸椎右侧凸患者分为两组,A组行胸腔镜下胸椎侧凸前路Eclipse矫形术,共8例,均为女性,平均年龄148岁,平均Cobb角54°,Risser征+++～++++。B组行开放小切口前路CDHTSRH矫形手术,共15例,男2例,女13例,平均年龄138岁,Cobb角平均57°,Risser征++～++++。对两组病例的手术时间、术中出血量、固定节段、术后引流量、矫正效果以及早期矫正丢失等进行分析。结果两组患者在年龄、Cobb角、侧凸柔软性和固定节段等方面均具有可比性。A组平均手术时间(360±72)min,术中平均出血量(629±145)ml,术后平均引流量(500±150)ml,平均固定节段(74±11)个,平均Cobb角矫正率(74±14)%,经6～18个月随访,近期矫正丢失率(86±27)%。B组平均手术时间(246±64)min,术中平均出血量(300±110)ml,术后平均引流量(210±90)ml,平均固定节段(78±09)个,平均Cobb角矫正率(70±12)%,近期矫正丢失率(46±19)%。A组与B组相比,侧凸矫正率相似(P>005),但手术时间、术中出血量、术后引流量,以及早期矫正丢失率等存在显著差异(P<005)。结论胸腔镜下胸椎侧凸前路矫形手术和开放小切口前路矫形手术具有各自的适应证和优缺点。

Objective To compare the early clinical results of thoracoscopic and mini open thoracotomic anterior correction for idiopathic thoracic scoliosis. Methods Twenty three cases with idiopathic right thoracic scoliosis were divided into 2 groups. Group A includes 8 females with average age of 14.8 years and average Cobb angle of 54°. The Risser sign was +++ ～ ++++. These patients were operated on with thoracoscopic Eclipse instrumentation. Group B covers 2 males and 13 females with average age of 13 8 years and average Cobb angle of 57°. The Risser sign was ++ ～ ++++. These patients were operated on with mini open thoracotomic anterior instrumentation. The operative time、blood loss、postoperative drainage、instrumented levels、curve correction and early loss of correction of both groups were analyzed. Results The patients of group A had average operative time of (360±72) min、(629±145) ml of intra operative blood loss、(7 4±1 1) of instrumented levels、(500±150) ml of post operative drainage、74±14% of curve correction rate and (8 6±2 7)% of early loss of correction after 6 ～ 18 m follow up. The patients of group B had average operative time of (246±64)min、(300±110)ml of intra operative blood loss、(7 8±0 9) of instrumented levels、(210±90)ml of post operative drainage、(70±12)% of curve correction rate and (4 6±1 9)% of early loss of correction. The curve correction rates of thoracoscopic and mini open thoracotomic anterior correction were not significantly different( P >0 05). But the operative time 、blood loss、postoperative drainage, and early loss of correction showed significant difference( P <0 05). Conclusions Thoracoscopic and mini open thoracotomic anterior correction for idiopathic thoracic scoliosis have their own indications. Both techniques are safe and effective to correct the idiopathic thoracic scoliosis with satisfied early results. But the early loss of correction of mini open thoracotomic anterior correction is significantly less than that of thoracoscopic anterior correction.