前路胸腔镜矫形内固定对特发性脊柱侧凸躯干旋转的矫正效果

Effect of Thoracoscopic Anterior Instrumented Fusion on Rib and Lumbar Hump Correction

【目的】比较前路胸腔镜矫形内固定与后路矫形内固定加胸廓成形术对特发性脊柱侧凸剃刀背畸形的矫正效果。【方法】对36例行前路胸腔镜矫形内固定及29例后路矫形内固定加胸廓成形术的特发性脊柱侧凸患者进行随访,通过脊柱侧凸测量尺测量术前及术后3、6、12和24月躯干旋转度(ATR),比较两组对剃刀背畸形矫形的效果。通过Nash&Moe方法测量胸腔镜组胸段顶椎旋转术前及术后矫正效果。【结果】术前胸腔镜组胸段平均ATR为(12.8±3.3)°,腰段平均ATR为(4.9±4.6)°。后路手术组胸段平均ATR为(13.4±3.8)°,腰段平均ATR为(5.0±4.4)°。术后3、6、12和24月随访时胸段平均ATR矫正率胸腔镜组为64%、58%、61%、59%,后路手术组为60%、56%、43%、53%。腰段平均ATR矫正率胸腔镜组为66%、42%、43%、50%,后路手术组为40.8%、51.9%、43.9%、53%。两组结果均无明显统计学差异。胸腔镜组胸段顶椎旋转度术前平均(2.0±0.5)°,末次随访为(0.4±0.6)°。【结论】前路胸腔镜矫形内固定术可以达到与传统后路矫形内固定加胸廓成形术对躯干旋转相若的矫形效果。其剃刀背畸形的矫形原理与胸腰段前路内固定术相似,均通过对椎体的去旋转得以实现。

[ Objective ] To compare the effect of thoracoscopic anterior instrumentation and conventional posterior instrumented fusion with thoracoplasty on rib and lumbar hump correction. [ Methods ] Thirty-six patients underwent thoracoscopic instrumented fusion （thoracoscopic group） ; and 29 patients underwent posterior segmental instrumentation with thoracoplasty （posterior group）. The angle of trunk rotation （ATR） was measured at thoracic （rib hump） and lumbar （lumbar hump） region using a scoliometer in standing forward bending position pre-operatively, and at 3, 6, 12, and 24 months after surgery. The effect of anterior instrumentation on apical vertebral de-rotation was calculated by Nash ＆ Moe method. [ Results] The mean pre-operative thoracie-ATR were 13.4 and 12.8; and lumbar ATR were 5 and 4.9 for the posterior-group and thoracoscopic-group respectively. Mean percentage improvement of thoracic-ATR were 60%, 56%, 43%, 53% in posterior-group; and 64%, 58%, 61%, 59% in thoracoscopic-group respectively at 3,6,12, and 24 months post surgery. Differences between groups were not statistically significant. Mean grade of thoracic apex rotation in thoracoscopic-group before surgery was 2.0-＋0.5, and at final follow-up was 0.4-＋0.6. One patient improved by three grades; 21 patients （58%） improved by two grades; and 13 patients （36%） improved by one grade and one remained same at final follow-up. Mean percentage improvement of lumbar ATR were 40.8%, 51.9%, 43.9%, 53% in posterior-group; and 66%, 42%, 43%, 50% in thoracoseopic-group respectively at 3,6,12 and 24 months with no statistically significant difference between the groups. [Conclusion] Thoracoscopic instrumentation resulted in rib and lumbar hump correction similar to that of conventional posterior instrumentation. Rib hump correction in thoracoscopie anterior instrumentation is due to its vertebral de-rotation effect, similar to that observed in anterior instrumentation for thoracolumbar scoliosis.