胸椎侧凸患者不同前入路手术对肩关节功能的影响

Shoulder functional assessment after anterior spine surgery for thoracic scoliosis:comparison among thoracotomic,mini-open thoracotomic and thoracoscopic approaches

目的:比较3种前路手术入路对胸椎侧凸患者术后1年以上肩关节功能的影响。方法:2001年10月至2007年1月在我院行前路手术并有完整临床资料的胸椎侧凸患者共57例,其中行传统开胸手术者19例,男9例,女10例,平均年龄14.3岁;行胸腔镜辅助小切口手术者20例,均为女性,平均年龄14.6岁;行锁孔胸腔镜手术者18例,男1例,女17例,平均年龄15.5岁。采用Constant评分法对患者术后肩关节功能进行评估,以对侧肩关节功能为内参照,评估3种不同前路手术入路患者术侧肩关节功能,比较3组患者术侧肩关节功能评分。结果:3种前路手术入路患者术后至少1年后术侧肩关节功能评分与对侧比较均无明显差异(P>0.05),3组患者术后至少1年后术侧肩关节功能评分亦无显著性差异(P>0.05)。结论:行前入路传统开胸手术、胸腔镜辅助小切口手术和锁孔胸腔镜手术对胸椎侧凸患者术后至少1年后肩关节功能无明显影响。

Objective：To compare the shoulder function after anterior spinal fusion among thoracotomic,miniopen thoracotomic and thoracoscopic approaches.Method：Between 2001 and 2007,fifty-seven patients with thoracic scoliosis who underwent anterior spinal fusion were reviewed.The patients were divided into 3 groups： thoracotomic instrumentation （n=19,mean age 14.3 years）,mini-open thoracotomic instrumentation （n=20,mean age 14.6 years）,and thoracoscopic instrumentation （n=18,mean age 15.5 years）.At a minimum follow-up of 1 year or more than 1 year,the ipsilateral and contralateral shoulder function of the patients was assessed with the Constant score.Result：At the follow-up,the postoperative function of the ipsilateral shoulder was similar among the three approaches （P〉0.05）.And,no significant differences were found in the shoulder function between the ipsilateral side and the contralateral side among the three approaches （P〉0.05）.Conclusion：In thoracic scoliosis patients with thoracotomic,mini-open thoracotomic and thoracoscopic approaches,no compromise is found in the function of the shoulder at the same side of which anterior thoracic spine surgery is performed.