【摘要】 [目的]评价胸腔镜下前路松解,前路或后路矫形治疗特发性脊柱侧凸的治疗效果。[方法]回顾本院自2003年7月~2005年12月施行的11例胸腔镜辅助下前路松解,前路或后路矫形治疗特发性脊柱侧凸病例。年龄12~16岁,平均14.6岁。LenkeⅠ型9例,术前冠状面Cobb s角54°~68°,平均59.7°;LenkeⅢ型2例,术前冠状面Cobb s角分别为58°和71°,平均64.5°。Bending X线片侧凸矫正率为21.8%~32.4%,平均26.4%。对11例患者在胸腔镜辅助下,采用等离子冷消融切除椎间盘松解,前或后路矫正。对手术后及随访时,冠状面和矢状面的Cobb s角进行测量,并对手术时间,术中出血量,围手术期并发症及矫正丢失等进行分析。[结果]平均手术时间290 min,平均术中出血171 ml。松解节段5~7个,平均4.4个。9例LenkeⅠ型术后Cobb s角平均20.4°,Cobb s角矫正率平均65.8%;2例LenkeⅢ型术后Cobb s角分别为20°和25°,Cobb s角矫正率平均65.1%;1例术后包裹性胸腔积液,术后平均随访18.6个月;1例出现矫正度丢失14°,无神经系统及血管损伤并发症。[结论]与传统开胸前路胸椎侧凸矫形手术相比,胸腔镜辅助下胸椎松解前后路矫形治疗脊柱侧凸是安全有效的微创手术,可达到与开胸手术同样效果。更多还原

【Abstract】 [Objective]To evaluate clinical results of videoassisted thoracoscopic anterior spine release combined with anterior or posterior correction of adolescent idiopathic scoliosis(AIS).[Method]Eleven cases of received video-assisted thoracoscopic anterior spine release followed by anterior or posterior instrumentation from July 2003 to December 2005 were reviewed.The average age at surgery was 14.6 years(ranged from 12 to 16 years).There were nine cases of Lenke type Ⅰ with average preoperative Cobb’s angle of 59.7°(ranged from 54° to 68°),and two cases of Lenke type Ⅲ,with average preoperative Cobb’s angle of 64.5°(ranged from 58°to 71°).The correction rate of thoracic curves in bending film averaged 26.4%(ranged from 21.8% to 32.4%).All 11 patients underwent release via endoscopic anterior resection of intervertebra disc through radiofrequency,and anterior or posterior correction.The coronal and sagittal Cobb’s angle after surgery,and at follow-up were measured.The operative time,intraoperational blood loss,peri-operative complications and loss of carrection were analyzed.[Result]The average operation time was 4 hours and 50 min.The blood loss during surgery averaged 171 ml.The average number of released levels was 4.4(ranged from 5 to 7).The average postoperative Cobb’s angle of 9 cases of Lenke type Ⅰ was 20.4° with curve correction rate of 65.5%.Postoperative Cobb’s angles of 2 cases of Lenke type Ⅲ were 20° and 25°,the correction rate of thoracic curve averaged 65.1%.One patient developed thoracic effusion.The average follow-up period was 18.6 months,only one of them with loss correction of 14°.No neurologic or vascular complication occurred.[Conclusion]Compared to the open anterior surgery,video-assisted thoracoscopic anterior spinal release is a safe and effective treatment for idiopathic scoliosis.It can avoid complications incurred by traditional thoracic surgery.It has satisfactory clinical results compared to conventional thoracotomic release for AlS.更多还原