胸椎侧凸胸腔镜下和开放小切口前路矫形术椎间融合面积研究  

Thoracoscopic and mini-open thoracotomic anterior correction for idiopathic thoracic scoliosis： comparison study for fusion effect

作　　者：邱勇[1] 王斌[1] 王渭君[1] 芮碧宇[1] 朱锋[1] 朱泽章[1] 

机构地区：[1]南京大学医学院附属鼓楼医院脊柱外科,210008

出　　处：《中华骨科杂志》2007年第4期248-253,共6页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金资助项目（30672131）

摘　　要：目的 比较特发性胸椎侧凸胸腔镜下前路矫形术与胸腔镜辅助下开放小切口前路矫形术的椎间植骨和融合效果。方法 将34例特发性胸椎右侧凸患者分为两组，A组10例患者接受胸腔镜下胸椎侧凸前路矫形术，平均年龄14．4岁，平均Cobb角52．9°。B组24例患者接受开放小切口前路矫形手术，平均年龄14．5岁，平均Cobb角45．4°。两组患者均采用自体肋骨作为移植骨。所有患者术后均行固定节段的CT扫描并获得完整的随访资料。通过测量术后CT片以及不同随访时间的X线片，对两组病例的椎间植骨面积百分比、矫形效果以及矫正丢失进行分析。结果两组患者在年龄、侧凸柔软性和固定节段等方面差异均无统计学意义，A组术前胸弯大于B组。两组患者术后平均椎间植骨面积百分比均超过40％，且组间差异无统计学意义（P〉0．05）。A组术后早期矫正丢失明显高于B组，差异有统计学意义（P〈0．05）。但两组在术后6个月后均无明显矫正丢失。结论 胸腔镜下胸椎侧凸前路矫形手术能够获得与开放小切口前路矫形手术同样满意的椎间植骨和融合效果，前者早期矫正丢失明显可能与固定的棒较细有关。Objective To compare the extent of spinal fusion after anterior instrumentation of idiopathic thoracic scoliosis with thoracoscopic or mini-open thoracotomic approach. Methods Thirty-four cases with idiopathic right thoracic scoliosis were divided into two groups. Group A included 10 patients with an average age of 14.4 years and average Cobb angle of 52.9°. Group B covered 24 patients with an average age of 14.5 years and average Cobb angle of 45.4°. The ribs up and down to the skin incision were resected for allografting. By measuring the CT images and anterior-posterior spinal X-ray films, the percentage of the bone graft in the intervertebral space, the curve correction and loss of correction in both groups were analyzed. Results No significant difference was found on the chronologic age, curve flexibility and fusion levels between two groups. The Cobb angle of main thoracic curve was larger in group A. The percentage of regenerated bone in the intervertebral space was high and no significant difference has been found between groups. Significant early loss of correction was found in group A when compared with group B （P〈 0.05）, however, no more loss of curve correction were found when compared 6 months post-operative X-ray between both groups. Conclusion Both thoracoscopic and mini-open thoracotomic anterior correction for idiopathic right thoracic scoliosis could get satisfied spinal fusion. The slim rod used might contribute to early loss of curve correction in group A.

关 键 词：脊柱侧凸 胸腔镜检查 脊柱融合术 椎间融合面积 

分 类 号：R686[医药卫生—骨科学]