微创手术治疗成人特发性脊柱侧凸的疗效观察  

Clinical outcomes of adult idiopathic scoliosis treated by MIS

作　　者：王永才 

机构地区：[1]解放军第463医院神经外科,辽宁沈阳110042

出　　处：《临床军医杂志》2014年第4期361-363,共3页Clinical Journal of Medical Officers

摘　　要：目的比较微创手术（MIS）与单纯后路矫形手术治疗成人特发性脊柱侧凸的疗效。方法2010年1月--2011年12月我院脊柱外科共收治成人特发性脊柱侧凸患者41例，年龄20—30（23．1±2．5）岁。根据患者手术方法不同分为两组，行MIS的19例患者为A组，行单纯后路矫形术的22例患者为B组。比较两组患者手术时间、出血量、住院时间、并发症情况、侧凸矫正率、腰顶椎偏距（AVT）和冠状面平衡情况。术后随访观察手术效果。结果平均手术时间和住院时间A组分别为（4．9±2．2）h和（10±7）d，B组分别为（6．9±1．3）h和（25±17）d，B组均明显长于A组（P〈0．05）。出血量A组为（314±57）ml，B组为（412±61）ml，B组明显多于A组（P〈0．05）。术后侧凸矫正率A组为（69．5±12．6）％，B组为（53．3±11．7）％，A组明显高于B组（P〈0．05）。术后胸椎后凸角A组为（22．6±8．5）°，B组为（21．4±7．6）°；躯干偏移距离A组为（14．2±7．5）mm，B组为（14．0±7．9）mm；腰顶椎偏距（AVT）A组为（14．5±12．4）mm，B组为（14．6±12．1）mm。两组患者胸椎后凸角、躯干偏移距离和AVT组间比较均无统计学意义（P〉0．05），组内术前与术后比较差异有统计学意义（P〈0．05）。术后不良事件有6例，A组1例，B组5例，A组的并发症发生率低于B组。结论MIS技术可以很好地矫正患者的脊柱畸形，在手术时间、住院时间、术中出血量及术后侧凸Cobb角矫正率等方面MIS均优于单纯后路矫形手术。Objective To study the clinical outcomes of minimally invasive surgery （MIS） in the treatment of adult idiopathic scol- iosis. Methods A total of 41 adult patients with idiopathic scoliosis aged 20 - 30 （23.1 ±2.5 ） years, who were treated from Jan- uary 2010 to December 2011, were recruited into the study. Group A （ n = 19） was treated by MIS and Group B （ n = 22） by pos- terior instrumentation. The two groups were compared on the aspects of surgical time, blood loss, hospital stay time, complications, postoperative correction rate, apical vertebral translation （AVT） and coronal trunk balance. Their surgical outcomes were observed via postoperative follow-up. Results Average surgical time and hospital stay length were much shorter in Group A [ （4.9 ± 2.2 ） h, （10 ±7）d] than in Group B[ （6.9 ±1.3）h,（25 ±11）d] （P 〈0.05）. The blood loses of Group A （314±57）ml was less than that of Group B （412 ± 61 ） ml （ P 〈 0.05）. The postoperative correction rate of Group A [ （69.5± 12.6） % ] was much higher than that of Group B [ （53.3 ± 11.7） % ] （P 〈 0 05 ）. Through intra-group comparison, both the two groups achieved similar postoperative thoracic sagittal alignment [（ 22.6 ± 8.5 ） ° vs （ 21.4±7.6 ）°, coronal trunk balance I （ 14. 2± 7.5 ） mm vs （ 14.0 ± 7.9 ） mm ] and AVT [ （ 14.5 ± 12.4） mm vs （ 14.6 ± 12.1 ） mm ] （ P 〉 0.05 ）, which were both significantly different from that of preopera- tion （P 〈 0.05）. There were 6 cases of complications, with 1 case in Group A and 5 cases in Group B. The incidence of Group A was much lower than that of Group B （ P 〈 O. 05 ）. Conclusion MIS is a safe and effective method to increase the correction rate of scoliosis. It is superior to simple posterior spinal instrumentation in the aspects of surgical time, blood loss, hospitalization dura- tion, complication and postoperative correction.

关 键 词：微创手术 成人特发性脊柱侧凸 后路矫形术 

分 类 号：R681[医药卫生—骨科学]