凹侧肋骨抬高胸廓成形对“剃刀背”畸形的矫正作用  

The application of concave side thoracoplasty for the correction of “razor back” deformity

作　　者：朱锋[1] 邱勇[1] 王斌[1] 朱泽章[1] 俞杨[1] 钱邦平[1] 马薇薇[1] 

机构地区：[1]南京大学医学院附属鼓楼医院脊柱外科,南京市210008

出　　处：《中国脊柱脊髓杂志》2007年第7期485-488,共4页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探讨凹侧肋骨抬高胸廓成形在脊柱侧凸后路手术中矫正“剃刀背”畸形的可行性。方法:自2000年10月～2005年10月,共有30例胸椎侧凸患者在我科施行后路三维矫形术,男13例,女17例;年龄10～31岁,平均17岁;先天性脊柱侧凸20例,特发性脊柱侧凸8例,马凡综合征2例。术前Cobb角60°～165°,平均118°;“剃刀背”畸形15°～60°,平均34.5°;双侧背部高度差为5～16cm,平均8.9cm。均同时在同一切口下行凹侧肋横突关节处截断并抬高肋骨胸廓成形,其中22例患者还同时行凸侧胸廓成形,凸侧肋骨切除的长度约为5～7cm。结果:每例患者肋骨抬高数为3～6根,平均4.5根。无手术死亡及严重并发症发生。术后Cobb角18°～85°,纠正率平均为58%;“剃刀背”畸形5°～18°,平均10.4°;双侧背部高度差1.5～5.2cm,平均3.4cm。随访12个月～5年,平均28个月,末次随访时Cobb角20°～90°,纠正率平均为56%;“剃刀背”畸形与术后无明显改变。结论:在严格掌握适应证的情况下仔细操作,凹侧肋骨抬高胸廓成形可使“剃刀背”畸形得到满意矫形效果。Objective：To evaluate the feasibility of concave side thoracoplasty for the correction of ＂razor back＂ deformity during the posterior operation for scoliosis surgery.Method：A total of 30 consecutive patients of thoracic scoliosis treated with posterior surgery and concave side thoracoplasty in the same incision were recruited for this retrospective study.The average age was 17 years（ranged 10-31 years）.The etiological classification of scoliosis was congenital for 20,idiopathic for 8,Marfan syndrome for 2.The average preoperative Cobb angle was 118°（ranged 60°-165°）,the average angle of rib prominence was 34.5°（ranged 15°-60°） and the difference in back-height was 8.9cm （ranged 5-16cm）.Twenty two patients were operated on with both concave and convex side thoracoplasty after the posterior fusion.Eight patients received concave side thoracoplasty alone.Result：The average number of rib raised was 4.5（3-6） on concave side.No severe or unrecoverable complications were recorded.The postoperative Cobb angle was 18°-85° and the correction rate averaged 58%.The average postoperative angle of rib prominence was 10.4°（5°-18°） ,and the average difference in back-height was 3.4cm （1.5-5.2cm）.All patients had a minimum of 12-month follow-up （ranged 12-60 months,mean 28 months）.The Cobb angle at last follow-up was 20°-90°,with the correction rate of 56%.No significant change of ＂razor back＂ deformity during follow up.Conclusion：With careful selection of indicated patients dedicated manipulation and dissection,concave side thoracoplasty can apparently improve the correction of the back deformity after posterior surgery.

关 键 词：脊柱侧凸 凹侧肋骨抬高 胸廓成形术 脊柱融合 

分 类 号：R682.3[医药卫生—骨科学] R687.3[医药卫生—外科学]