系统评价特发性胸椎侧弯胸腔镜下矫形的疗效和并发症  

The outcomes and complications of thoracic idiopathic scoliosis via thoracoscopic instrumentation： a sys-tematic review

作　　者：王渭君[1] 邱勇[1] 江华[1] 王斌[1] 朱泽章[1] 朱锋[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 210008

出　　处：《中华小儿外科杂志》2012年第6期401-407,共7页Chinese Journal of Pediatric Surgery

摘　　要：目的通过系统文献回顾来评价当前胸腔镜技术在特发性胸椎侧弯矫形内固定中的应用价值。方法计算机检索Medline、EMbase、中国生物医学文献数据库、中国期刊全文数据库和万方数据资源系统，纳入2011年6月以前发表的关于胸腔镜下特发性胸椎脊柱侧弯矫形的疗效、肺功能、患儿生活质量评分、并发症的临床研究，进行系统评价。结果共纳入26个研究，其中13篇文献用于手术疗效及并发症分析，11篇用于术后肺功能分析，4篇用于术后SRS评分分析。共488例胸椎侧弯患儿（其中7例为非特发性胸椎侧弯）接受胸腔镜下矫形内固定手术，手术平均时间343min、出血量434ml，平均固定节段6．7个，侧弯平均矫正率57．5％。胸椎后弯由术前16．4。矫正至术后26．4°胸腔镜下矫形与传统后路钩棒或前路矫形效果无明显差异。125例（25．6％）患儿发生并发症，以内固定相关并发症最常见。患儿术后肺功能明显下降，但在术后1年时恢复至术前水平。远期随访显示患儿生活质量评分较高，对手术满意度好。结论胸腔镜下特发性胸椎侧弯矫形内固定可获得与传统手术入路一样的矫形效果，术后肺功能恢复快，主观功能评分较好，但该手术技术的掌握具有明显学习曲线，手术时间长、出血量大、并发症发生率较高。对于适合该手术且对术后恢复及手术瘢痕要求较高的患儿，胸腔镜下矫形内固定仍然是较好的选择。Objective To summary and evaluate the application value of thoracoscopic instru- mentation on thoracic idiopathic scoliosis through literature review. Methods Publications of thoraco- seopic instrumentation for thoracic idiopathic scoliosis before Jun 2011 were reviewed. Surgical out- comes, complications, pre- and postoperative pulmonary function and scoliosis research society （SRS） questionnaires were targeted for systemic review. Results Twenty-six publications correlated to our study were identified. Totally 488 patients with scoliotic （seven of them were not idiopathic scoliosis） underwent thoracoscopic instrumentation in thirteen studies. The mean operation time was 343 mi- nutes, intra-operative blood loss was averagely 434 ml and 6. 7 segment of instrumentation was done in them. The correction rate is up to 57. 5% while the thoracic kyphosis was increased from 16. 4° in op- eration to 26. 4°in post-surgery. These angular corrections were found to be comparable to conven- tional anterior thoracotomy correction and posterior procedures using hooks, but less than those using pedicle screws. Complications were reported in125 patients （25.6%）, and most of them were instru- mentatiowrelated complications. Although pulmonary function decreased significantly after operation, it would recover to normal level after one year. SRS questionnaire showed satisfactory efficacy and cosmetics. Conclusions Thoracoscopic instrumentation is comparable in terms of curve correction with conventional anterior or posterior procedures, and also has faster pulmonary function recover, as well as the higher SRS questionnaire scores. These advantages, however, seem to be offset by the sharp learning curve, the increased operative time, and intra-operative bleeding and potential complication. Although this, the thoracoscopic instrumentation is still a good procedure for patients, especially for those who concern on the post-operative recovery and cosmetics.

关 键 词：脊柱侧弯 胸腔镜 手术后并发症 生活质量 系统分析 

分 类 号：R687.3[医药卫生—骨科学]