CAJ | 학술논문

目的：评价胸腔镜下前路松解联合后路矫形治疗特发性脊柱侧凸畸形的临床疗效。方法2004年4月至2008年7月，我院采用胸腔镜辅助下前路松解及后路矫正术治疗42例特发性脊柱侧凸患者，其中男17例，女25例，年龄11～23岁，平均14.6岁。术前冠状面主弯 Cobb’s 角69°～132°，平均(76.5±6.2)°，柔韧度(26.8±5.2) %；按 Lenke 分型，I 型25例，II 型13例，III 型4例。左胸弯 7例，右胸弯35例。术前肺功能检查均有中－重度肺通气储备功能下降，7例术前有下肢浅表感觉减退。全麻下取侧卧位在胸腔镜辅助下完成前路胸椎椎间隙松解与植骨融合，一期或二期行脊柱侧凸后路矫形、内固定及植骨融合术。术后1周、3个月、6个月、1年、2年及末次随访时对冠矢状面 Cobb’s 角进行测量，记录和分析手术时间、术中出血量、围术期并发症。结果42例顺利完成手术，无神经系统及血管损伤等并发症，前路松解平均手术时间(108±22) min，平均术中出血量(95±25) ml。术后胸腔闭式引流量(120±35) ml。切口均一期愈合。每例患者完成4～7(平均5.8)个椎间隙的松解。后路矫形完成后冠状面主弯 Cobb’s 角为12°～78°，平均(32.5±4.5)°，平均矫正率为(57.5±8.5) %。所有患者术后获15～28个月随访，平均(23±3.2) 个月，末次随访冠状面胸椎 Cobb’s 角平均(33.2±5.0)°，冠状面矫形较术后无明显丢失，矢状面脊柱生理曲度恢复正常，外观明显改善。结论与传统开放术式比较，胸腔镜辅助下前路松解联合后路矫形术能有效松解胸椎侧凸，创伤小，显露清晰，并能达到同样理想的矫正效果。
목적：평개흉강경하전로송해연합후로교형치료특발성척주측철기형적림상료효。방법2004년4월지2008년7월，아원채용흉강경보조하전로송해급후로교정술치료42례특발성척주측철환자，기중남17례，녀25례，년령11～23세，평균14.6세。술전관상면주만 Cobb’s 각69°～132°，평균(76.5±6.2)°，유인도(26.8±5.2) %；안 Lenke 분형，I 형25례，II 형13례，III 형4례。좌흉만 7례，우흉만35례。술전폐공능검사균유중－중도폐통기저비공능하강，7례술전유하지천표감각감퇴。전마하취측와위재흉강경보조하완성전로흉추추간극송해여식골융합，일기혹이기행척주측철후로교형、내고정급식골융합술。술후1주、3개월、6개월、1년、2년급말차수방시대관시상면 Cobb’s 각진행측량，기록화분석수술시간、술중출혈량、위술기병발증。결과42례순리완성수술，무신경계통급혈관손상등병발증，전로송해평균수술시간(108±22) min，평균술중출혈량(95±25) ml。술후흉강폐식인류량(120±35) ml。절구균일기유합。매례환자완성4～7(평균5.8)개추간극적송해。후로교형완성후관상면주만 Cobb’s 각위12°～78°，평균(32.5±4.5)°，평균교정솔위(57.5±8.5) %。소유환자술후획15～28개월수방，평균(23±3.2) 개월，말차수방관상면흉추 Cobb’s 각평균(33.2±5.0)°，관상면교형교술후무명현주실，시상면척주생리곡도회복정상，외관명현개선。결론여전통개방술식비교，흉강경보조하전로송해연합후로교형술능유효송해흉추측철，창상소，현로청석，병능체도동양이상적교정효과。
Objective To evaluate the clinical effects of video-assisted thoracoscopic anterior spine release combined with posterior correction for adolescent idiopathic scoliosis ( AIS ).Methods From April 2004 to July 2008, 42 cases of AIS ( Lenke I in 25 cases, Lenke II in 13 and Lenke III in 4 cases, left scoliosis in 7 and right scoliosis in 35 ) underwent video-assisted thoracoscopic spine release combined with bone graft fusion, and then posterior internal ifxation, correction, bone graft fusion during stage I or stage II, in which there were 17 males and 25 females with an average age of 14.6 years ( range: 11-23 years ). Preoperative Cobb’s angle at the coronal plane was averaged ( 76.5± 6.2 ) ° ( range: 69°-132° ). Flexibility was ( 26.8±5.2 ) %. Preoperative pulmonary function test: all patients were of moderate-severe decrease in pulmonary reserve ventilation function. All patients had normal muscle strength and muscle tension, 7 cases had decrease of the superifcial sensation in lower limbs. Anterior thoracoscopic vertebral space release and bone grafting fusion in lateral position under general anesthesia were conducted. The coronal and sagittal Cobb’s angles were measured at 1 week, 3 months, 6 months, 12 months, 24 momths and at the ifnal follow up. Operative time, intraoperative blood loss, perioperative complications and correction loss were recorded and analyzed. Results All surgeries went smoothly without any complications such like neurologic or vascular damage. All incisions were of primary healing. The mean anterior release operation time was ( 108±22 ) min and intraoperative blood loss was ( 95±25 ) ml with postoperative thoracic closely-drained lfuid of ( 120±35 ) ml. The average number of released levels were 5.8 ( range: 4-7 ). The average coronal Cobb’s angle after posterior correction was ( 32.5±4.5 ) ° ( range:12°-78° ) and ( 33.2±5.0 ) ° at ifnal follow up. The mean correction rate was ( 57.5±8.5 ) %. The average follow-up was of ( 23±3.2 ) months ( range: 15-28 months ) revealed that the physiological curve of the spine at the sagittal plane restored to the normal and all patients gained signiifcant improvement of pulmonary function, psychological condition and appearance.Conclusions Compared to the traditional open surgery, anterior thoracoscopic spine release can effectively release the scoliosis with less surgical injuries and clearer exposure of the spine, which can obtain similar ideal corrective results.