青少年特发性胸椎侧凸胸腔镜辅助前路矫形的疗效

Mini-open anterior corrective surgery with assistance of thoracoscopy for thoracic idiopathic scoliosis

目的介绍特发性胸椎侧凸胸腔镜辅助小切口前路矫形手术的技术要点和手术适应证选择,并对其临床结果进行分析。方法2001年7月至2006年1月共进行胸椎侧凸小切口前路矫形手术37例,男4例,女33例,平均年龄14.1岁,冠状面Cobb角平均56°,Lenke分型ⅠA 14例,ⅠB 14例,ⅠC 9例,均为胸椎右侧凸,Risser征++～++++,对手术时间、术中出血量、固定节段、矫正效果以及矫正丢失等进行分析。结果平均手术时间220 min,术中出血量平均320 ml,平均固定节段7.8个,术后Cobb角平均16.8°,平均侧凸矫正率70%,随访18～36个月,平均矫正丢失4.6%,无内固定并发症发生。结论胸椎侧凸前路胸腔镜辅助小切口矫形手术在减少手术创伤、降低麻醉要求、相对胸腔镜手术更为宽松的适应证选择基础上,可以达到传统开胸前路矫形或后路矫形手术的临床效果、且没有增加手术并发症。

Objective To introduce the mini-open anterior correction under video assisted thoracoscopy for thoracic idiopathic scoliosis and report its clinical results. Methods From July 2001 to 2006,37 cases of right thoracic idiopathic scoliosis were surgically corrected with mini-open anterior instrumentation. There were 4 males and 33 females with average age of 14. 1 years and average Cobb angle of 56°. Fourteen cases with Lenke ⅠA 14 cases, ⅠB ＋＋ - ＋＋＋ 14 cases, ⅠC 9 cases. The Risser sign was ＋＋ - ＋＋＋. The operative time, blood loss, instrumented levels, correction rate and loss of correction were analyzed. Results The operative time averaged 220 min. The intraoperative blood loss averaged 320 ml. The average number of instrumented levels was 7.8. The postoperative Cobb angle was 16. 8° on average with correction rate of 70%. With a follow-up of 18 -36 months, the loss of correction averaged 4. 6%, but no hardware complications. Conclusion The clinical results of mini-open anterior correction under thoracoscopy for thoracic idiopathic scoliosis were satisfactory. It may minimize the complications of classical thoracotomic anterior correcion and may reduce the high requirement for anesthesia, long operative time and high cost of thoracoscopic anterior instrumentation.