胸腔镜下前路松解术在脊柱侧弯矫正术中的应用  

RELEASING ANTERIOR PART OF SPINE UNDER VIDEO-ASSISTED THORACOSCOPE FOR TREATMENT OF ADOLESCENT IDIOPATHIC SCOLIOSIS

作　　者：刘立岷[1] 宋跃明[1] 李涛[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2007年第8期825-828,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的介绍胸腔镜下行前路松解术治疗脊柱侧弯的疗效。方法2004年4月～2006年7月对24例脊柱侧弯患者进行治疗。其中男9例,女15例;年龄11～21岁,平均14.7岁;均为特发性脊柱侧弯,发现脊柱侧弯1年5个月～9年。术前胸椎冠状面Cobb角为65～125°(平均为78.3°);按Lenke分型,型17例,型7例;右胸弯22例,左胸弯2例。5例患者下肢浅感觉减退;所有患者的下肢肌力、肌张力正常;均有中-重度的肺通气储备功能下降。全麻下侧卧位建立胸腔镜工作孔道后,行胸椎椎间隙松解与植骨融合;一期或二期完成脊柱侧弯后路的矫形、内固定、植骨融合。结果患者均安全度过围手术期;术中出血50～200ml,平均100ml,术后胸腔闭式引流100～150ml;切口均期愈合,每例完成4～6个椎间隙松解,平均5.5个。后路矫形完成后冠状面Cobb角为25～75°,平均45.6°,矢状面生理曲度正常,外观改善。术后均获随访3～18个月,平均9.3个月。双肺纹理清晰,矫形段脊柱融合,无矫形度的丢失,可正常生活和工作,外观明显改善,心理状态和社会参与度显著提高。结论胸腔镜下脊柱前路松解术可有效松解胸椎侧弯,提高脊柱的柔软性,其优点为创伤小,显露脊柱快而清晰。Objective To evaluate the safety and efficacy of the operation performed under the video-assisted thoracoscope to release the anterior part of the spine of the patient with severe adolescent idiopathic scoliosis （AIS）. Methods From April 2004 to July 2006, 24 patients with AIS （illness course, 1.5-9 years; Lenke Ⅰ in 17 patients, Lenke Ⅱ in 7; right scoliosis in 22, left scoliosis in 2）, among whom there were 9 males and 15 females, with an average age of 14. 7 years （range, 11-21 years） at the time of the operation. Before operation, the thoracic vertebral Cobb anger at the coronal plane was averaged 78.3°（range, 65-125°）. All the patients had normal muscle strength and muscle tension in their lower limbs, but 5 of the patients had a decrease of the superficial sensation in their lower limbs. All the patients had a moderately or severely decreased lung reserve function. Under general anesthesia, the patient was placed in the lateral position to set up a work channel for thoracoscopy. The releasing of the thoracic intervertebral space and the confluence of the bone grafts were performed. During Stage Ⅰ or Stage Ⅱ , the orthopedic procedures for the posterior part of the scoliosis spine, the internal fixation, and the confluence of the bone grafts were completed. Results All the patients survived the period of perioperation. During operation, there was a hemorrhage of 50-200 ml, averaged 100 ml, with a postoperative thoracic closely-drained fluid of 100-150 ml. The incision was healed by the first intention. Each patient underwent the release of 4-6 intervertebral spaces, with an average of 5.5 spaces released. The average coronal Cobb angle was 45.6°（range, 25- 75°）. The physiological curvature at the sagittal plane was normal, with an improved shape of the spine. The follow-up for 3-18 months averaged 9.3 months revealed that the bilateral pulmonary markings were clear, with confluence of the orthopedic segment of the spine. The patients could live and work normally, and had a sig

关 键 词：胸腔镜 脊柱侧弯 前路松解术 

分 类 号：R687.3[医药卫生—骨科学]