凸侧肋骨后支切除治疗脊柱侧弯剃刀背畸形  

Thoracoplasty with posterior branch of ribs resection in the posterior approach surgical treatment of rib prominence in scoliosis

作　　者：童祎[1] 冯大雄[1] 叶飞[1] 

机构地区：[1]泸州医学院附属医院脊柱外科,四川泸州646000

出　　处：《西部医学》2012年第8期1553-1555,共3页Medical Journal of West China

摘　　要：目的探讨凸侧肋骨后支切除治疗脊柱侧弯剃刀背畸形的优点。方法采用后路松解﹑椎体截骨矫形﹑椎弓根螺钉内固定﹑植骨融合治疗脊柱侧凸畸形31例,其中16例经后正中切口凸侧2～4根肋骨后支切除治疗剃刀背畸形,15例采用局部剃刀背2～4根肋骨切除。观察两种治疗剃刀背畸形术式的手术时间、出血量、反常呼吸发生率、术后肺部并发症发生率及脊柱侧凸Cobb角、后凸Cobb角﹑剃刀背高度的矫正率。结果术后随访10～24个月,平均18个月,术后切口均Ⅰ期愈合。经后正中切口凸侧2～4根肋骨后支切除治疗剃刀背畸形平均每根肋骨切除时间为(5.3±1.2)min,出血量(65±11.6)ml,未发生局部反常呼吸,壁层胸膜撕裂1例,侧凸Cobb角矫正率平均为64.4%,后凸Cobb角矫正率平均为-15%,剃刀背高度矫正率平均62%。局部剃刀背2～4根肋骨切除治疗剃刀背畸形平均每根肋骨切除时间为(8.6±1.6)min,出血量(128±19.6)ml,局部反常呼吸5例,壁层胸膜撕裂3例,侧凸Cobb角矫正率平均为67.6%,后凸Cobb角矫正率平均为-20%,剃刀背高度矫正率平均67%。两组在脊柱侧凸Cobb角、后凸Cobb角﹑剃刀背高度的矫正率上无统计学差异(P>0.05)。在手术时间、出血量、反常呼吸发生率、术后肺部并发症发生率上,凸侧肋骨后支切除术要明显少于剃刀背肋骨切除术。结论凸侧后支肋骨切除胸廓成形手术治疗剃刀背畸形矫形满意,手术创伤更小,术中及术后肺部并发症少,对呼吸功能影响较小。Objective To investigate the advantage of thoracoplasty with posterior branch of ribs excision in the posterior surgical treatment of rib prominence in scoliosis.Methods Clinical data of 31 patients with scoliosis,including 13 males and 18 females corrected by posterior approach surgical procedures were retroactively studied.16 patients received thoracoplasty with posterior branch of ribs resection in correction procedures（group A） while 15 patients received thoracoplasty with long segment ribs resection（group B）.The coronal Cobb angle of major curves,height of rib hump,Cobb angel of kyphosis,time of operation,blood lose and Pulmonary complications were observed.Results The mean correction rate of coronal Cobb angle,Cobb angel of kyphosis,and the height of rib hump in group A were 64.4%,-15% and 62% while that was 67.6%,-20% and 67% in group B（P〉0.05）.Complications related to the thoracoplasty in groupB included intra-operative tear of parietal pleura（3 cases,20%）,paradoxical breathing（5 cases,33.3%）,were significantly higher than these in group A1（6.25%）,0）.An average time of operation in group A was 5.3 min a rib,shorter than that in group B（8.6min）.An average blood lose in group A was 65ml,while that in group B was 128 ml.A satisfactory recovery was achieved after appropriate treatment in most patients.Conclusion The thoracoplasty with posterior branch of ribs resection is an efective and impressive way to improve the correction rate and cut down the height of rib hump,with a low incidence of pulmonary complications.

关 键 词：脊柱侧凸 胸廓成形术 剃刀背畸形 并发症 

分 类 号：R687.31[医药卫生—骨科学]