胸腔镜下前路矫形治疗青少年特发性胸椎侧凸  

Anterior thoracoscopic techniques for the correction of adolescent idiopathic scoliosis

作　　者：杨操[1] Geoffrey Askin 杨述华[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,武汉430022 [2]Department of Orthopaedics,Mater Children's Hos-pital

出　　处：《中华骨科杂志》2004年第2期70-73,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨胸腔镜下前路矫形治疗青少年特发性胸椎侧凸的疗效。方法青少年特发性胸椎侧凸33例,男7例,女26例;年龄10～18岁,平均13.6岁。Lenke分型均为Ⅰ型,其中24例为ⅠA型,9例为ⅠB型。术前Cobb角:冠状面原发性胸弯平均57.4°(43°～68°),代偿性腰弯平均32.0°(20°～47°);27例存在胸椎后凸不足畸形,胸椎后凸平均6.3°(0°～18°)。手术方法为前路胸腔镜下切除椎间盘进行松解,应用CDHorizonEclipse矫形内固定,同时在椎间隙植骨。随访期间测量冠状面Cobb角及矢状面胸椎后凸成角,了解冠状面和矢状面畸形矫正情况。结果固定节段包括T4～T12,平均7.4个。平均手术时间为3h48min,平均术中出血量为308ml,平均住院时间4.4d。全部病例随访6～36个月,平均20.6个月。末次随访时原发性胸弯平均矫正60.2%,代偿性腰弯自然矫正平均50.3%,胸椎后凸平均矫正20.4°。1例出现假关节形成及内固定折断,2例出现胸壁麻木。结论胸腔镜下前路矫形治疗胸椎侧凸具有创伤小、术后恢复快等优点,能达到与开胸前路矫形术同样的矫形效果。Objective To evaluate the effectiveness of thoracoscopic techniqu es for the anterior correction of adolescent idiopathic scoliosis. Methods Betwe en March 2000 and November 2002, 33 patients with adolescent idiopathic scoliosi s were selected to undergo thoracoscopic instrumentation, correction, and fusion . There were 26 females and 7 males. The average age at surgery was 13.6 years ( range, 10 to 18 years). All patients had idiopathic thoracic curves of typeⅠacc ording to the Lenke classification system, 24 of whom were typeⅠA, and 9 typeⅠ B. The average preoperative Cobb angle of the primary thoracic curve was 57.4°( range, 43° to 68°), and that of the compensatory lumbar curve was 32.0°(range , 20° to 47°). 27 patients were an averaged 6.3° of hypokyphosis (range, 0° to 18°). All 33 patients underwent endoscopic anterior release, instrumentation , correction and intervertebral fusion using the CD Horizon Eclipse system. Para meters including coronal Cobb angle of the primary thoracic curve, the compensat ory lumbar curve and thoracic kyphosis, were measured to assess coronal and sagi ttal correction. Results The instrumented levels were from T4 to T12. The averag e number of levels instrumented for each patient was 7.4 (range, 5 to 9). Operat ive times averaged 3 h and 48 min (range, 2 h 40 min to 5 h 30 min). Blood loss averaged 308 ml (range, 100 to 500 ml). Hospitalization averaged 4.4 days (range , 3 to 9 days). The average follow-up period was 20.6 months (range, 6 to 36 mon ths). The correction for the primary thoracic curve averaged 60.2%, and the comp ensatory lumbar curve averaged 50.3%. Correction with hypokyphosis averaged 20.4 °. One patient developed pseudoarthrosis and rod fracture. Two patients experie nced transient chest wall numbness. Conclusion Anterior thoracoscopic correction of adolescent idiopathic scoliosis has the advantages of minimal invasion and s horter rehabilitation period. It can also provide the same corrective effect com paring to conventional open thoracotom

关 键 词：胸腔镜 前路矫形 治疗 青少年 特发性胸椎侧凸 

分 类 号：R687[医药卫生—骨科学]