青少年特发性胸椎侧凸胸腔镜下矫形内固定手术的远期疗效  

Long term outcome of video-assisted thoracoscopic surgery for thoracic adolescent idiopathic scoliosis

作　　者：王渭君[1] 邱勇[1] 王斌[1] 朱泽章[1] 朱峰[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,210008

出　　处：《中华外科杂志》2012年第4期323-327,共5页Chinese Journal of Surgery

基　　金：国家自然基金青年科学基金资助项目（81101335）

摘　　要：目的研究胸腔镜下矫形内固定手术治疗青少年特发性胸椎侧凸（T－AIS）的远期疗效和并发症。方法回顾性分析2002年6月至2006年12月采用胸腔镜下矫形内固定手术治疗T－AIS、随访5年以上的9例患者术前、术后3个月、2年和末次随访的X线片，测量冠状面上胸主弯和腰弯、矢状面上T5-T12、T10-L2和T12-S1的Cobb角。患者均为女性，手术时年龄11-16岁，平均14．3岁。记录其术后和随访时的并发症。在末次随访时采用中文版SRS-22问卷进行患者的生活质量评分。采用重复测量比较和配对t检验比较术前、术后和随访时的影像学指标。结果随访时间5．0-7．5年，平均6．2年。患者术前胸椎侧凸Cobb角平均51°±8°，术后3个月、2年和末次随访时分别为20°±-8°、21°±12°和25°±13°。与术后3个月相比，术后2年和末次随访时侧凸均有矫正丢失但差异无统计学意义（P〉0．05）。术后和末次随访时的腰弯Cobb角、矢状面参数变化差异无统计学意义（P〉0．05）。术后2年1例患者发生断棒、1例患者发生近端AddingOn现象，由于侧凸无明显加重，2例患者均未行翻修手术。末次随访时患者SRS-22总体平均分为4．3±0．3。结论接受胸腔镜下矫形内固定手术治疗的T-AIS患者手术2年后仍可出现矫正丢失和内固定相关并发症，所以尽管手术后患者生活质量和对该手术的满意度均较高，但在选择胸腔镜下矫形内固定手术时应严格把握适应证。Objective To study the long term outcomes and complications of video-assisted thoracoscopic surgery （VATS） in correcting thoracic adolescent idiopathic scoliosis （T-AIS） with more than five-year follow-up. Methods The T-AIS patients underwent corrective surgery by VATS between June 2002 and December 2006 and experienced more than five-year follow-up were retrospectively reviewed. Nine female patients with T-MS were recruited with a mean age of 14. 3 years （range 11-16 years） at operation. Radiological parameters including thoracic and lumbar curves, thoracic kyphosis （Ts-T12）, sagittal alignment of the thoracolumbar junction （ T10-L2 ） and lumbar lordosis （ TI2-S1 ） were measured on the X-rays taken preoperatively, 3 months, 2 year postoperatively and at latest follow-up. Complications occurred after operation and during follow-up were retrieved. The Chinese edition SRS-22 was finished by patients at the latest follow-up. Repeated-measures analysis of variance and paired t test were used for statistical analysis. Results The patients were followed for a mean of 6. 2 years （5-7. 5 years） after VATS. The mean thoracic curve was corrected from 51°±8°preoperatively to 20°±8° at 3 months post-operation, and 21°±12° and 25°±13° at 2 year post-operation and latest follow-up, respectively. During the follow-up, no significant changes were observed regarding to coronal and sagittal radiological parameters （ P 〉 0. 05 ）. Rod breakage occurred in 1 patient and Adding on was found in another one patient 2 year post-operation. Revision surgery was not needed for the solid fusion achieved and lack of correction loss. The mean score of SRS-22 at final follow-up was 4. 3±0. 3, with high score in most of the domains. Conclusions Loss of curve correctionand implant-related complication are found in VATS-treated T-A1S patients at the long-term follow-up. Although the patients show high scores in SRS-22, which indicated higher functional outcome and satisfaction to the operation, specia

关 键 词：脊柱侧凸 胸腔镜检查 矫形外科手术 治疗结果 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]