胸腔镜辅助下治疗特发性脊柱侧凸（医学论文）

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1、胸腔镜辅助下治疗特发性脊柱侧凸作者：肖联平，江毅，田永刚，刘智，季淑青，尹庆伟,李晓东，福嘉欣【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Cobbs角54。-68°，平均59.7°;Lenkem型2例，术前冠状面Cobbs角分别为58。和71。，平均64.5°。BendingX线片侧凸矫正率为21.8%〜32.4

2、%,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Cobbs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290min,平均术中出血171ml。松解节段5~7个，平均4.4个。9例LenkeI型术后Cobbs角平均20.4。,Cobbs角矫正率平均65.8%;2例LenkeDI型术后Cobbs角分别为20。和25°,Cobbs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

3、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。【关键词】胸腔镜；脊柱侧凸；前路;后路;矫形；内固定VideoassistedthoracoscopicanteriorspinereleasefollowedbyanteriororposteriorcorrectionofadolescentidiopathicscoliosisIIAbstract:[Objective]Toevaluateclinic

4、alresultsofvideoassistedthoracoscopicanteriorspinereleasecombinedwithanteriororposteriorcorrectionofadolescentidiopathicscoliosis(AIS)・[Method]ElevencasesofreceivedvideoassistedthoracoscopicanteriorspinereleasefollowedbyanteriororposteriorinstrumentationfromJuly2003toD

5、ecember2005werereviewed.Theaverageageatsurgerywas14.6years(rangedfrom12to16years)・TherewereninecasesofLenketypeIwithaveragepreoperativeCobbsangleof59.7°(rangedfrom54°to68°),andtwocasesofLenketypeHI,withaveragepreoperativeCobbsangleof64.5°(rangedfrom58°to71°)・Thecorrect

6、ionrateofthoraciccurvesinbendingfilmaveraged26.4%(rangedfrom21.8%to32.4%).All11patientsunderwentreleaseviaendoscopicanteriorresectionofintervertebradiscthroughradiofrequency?andanteriororposteriorcorrection.ThecoronalandsagittalCobbsanglea仕ersurgery,andatfollowupwereme

7、asured.Theoperativetime,intraoperationalbloodloss,perioperativecomplicationsandlossofcarrectionwereanalyzed・[Result]Theaverageoperationtimewas4hoursand50min.Thebloodlossduringsurgeryaveraged171ml.Theaveragenumberofreleasedlevelswas4.4(rangedfrom5to7)・Theaveragepostoper

8、ativeCobbsangleof9casesofLenketypeIwas20.4°withcurvecorrectionrateof65.5%.PostoperativeCobbsanglesof2casesofLenketype