特发性胸椎侧凸胸腔镜下前路矫形和小切口前路矫形置钉精确性比较分析

Comparative study on precision of vertebral screw insertion for idinnathic thoracic scoliosis between by thoracoscopy and by mini anterior thoracotomy

目的比较特发性胸椎侧凸胸腔镜和小切口前路矫形椎体钉置入的精确性及其意义。方法胸腔镜下胸椎侧凸前路矫形术共10例(A 组),平均年龄14.4岁,平均 Cobb 角52.9°;小切口胸椎侧凸前路矫形术共21例(B 组),平均年龄14.4岁,平均 Cobb 角45.4°。在固定节段椎体横断面CT 上测量螺钉进钉点、进钉方向及其与主动脉和椎管的解剖关系以比较两组的置钉准确性。评价两组螺钉的安全性、双皮质固定和置钉满意度。结果 A 组使用胸椎椎体钉73枚,B 组使用162枚。两组置钉准确性测量结果差异无统计学意义(户>0.05)。A 组和 B 组距离主动脉≥1 mm 的螺钉分别占89.0%和80.2%,双皮质固定率分别为89.O%和87.0%,置钉满意率分别为74.0%和66.0%,两组间总体及各相应部位比较差异均无统计学意义(P>0.05)。结论特发性胸椎侧凸胸腔镜和小切口前路矫形术置入的椎体钉具有同样的准确性、安全性、双皮质固定率以及置钉满意率。

Objective To compare the precision of the vertebral screw insertion in treating idiopathic thoracic scoliosis by thoracoscopy with that by mini anterior thoracotomy. Methods Ten patients with an average Cobb angle of 52.9° were operated thoracoscopically （group A）, and twenty-one patients with an average Cobb angle of 45.4° were operated by mini anterior thoracotomy （group B）. In order to determine the accuracy of screw placement, several parameters were measured postoperatively on each instrumented level of CT scan, including the entry point and entry direction of screw, the relationships between the screw tip and aorta as well as spinal canal. The safety of screw placement was determined at the position of screw to the vertebral canal and the aorta, and the results of CT analysis were designated as; D, the screw tip was distant from the aorta （≥1mm） ; A, the screw tip was adjacent to the aorta （ 〈1mm） ; C, the screw tip was felt to be against the aorta and creating contour deformity. The screw which had a bicortical purchase but was distant from the aorta and vertebral canal was defined as a satisfied screw. Results 73 screws were inserted into patients of Group A, and 162 into patients in Group B. Parameters measured on CT image and X- ray showed no difference between these two groups（ P 〉0.05）. There is no difference （P 〉 0.05 ） between A and B group of percentages in D （89.0% vs. 80.2% ）, in bicortical purchase （89.0% vs. 87.0% ） , and in satisfaction of screw placement （74.0% vs. 66.0% ）. Conclusion Thoracoscopic and mini-open thoracotomic anterior correction are safe and effective to correct idiopathic right thoracic scoliosis with satisfied correction. Vertebral screws placed by both techniques have the same satisfied accuracy, safety, bicortical purchase and the satisfaction rate either in total screws or in the corresponding area.