胸腔镜；脊柱畸形；脊柱侧弯_____胸腔镜；

经胸腔镜前路松解后路矫形一期治疗僵硬性脊柱侧弯10例初步报告

http://www.100md.com 《中国矫形外科杂志》 2006年第11期

胸腔镜；脊柱畸形；脊柱侧弯,,胸腔镜；,脊柱畸形；,脊柱侧弯,1临床资料与方法,2结果,3讨论,参考文献：

     摘要：[目的]观察经胸腔镜前路松解后路矫形一期治疗僵硬性脊柱侧弯的效果。临床资料：共10例特发性脊柱侧弯(King Ⅱ6例，King Ⅲ 3例，King Ⅳ 1例)。男6例，女4例；年龄14~21岁，平均172岁。冠状面Cobbs角67°~125°(平均919°)，胸椎侧凸柔软度为1930%~365%(平均283%)。[方法]全麻下(单或双肺通气)侧卧位胸腔镜下以顶椎为中心做5~6个椎间盘及纤维环的切除达到松解植骨，术毕改俯卧位行后路三维矫形术。[结果]本组患者均前路成功松解胸椎，手术时间120~150 min，术中出血量100~200 ml(平均151 ml)，术后引流量100~150 ml;同期行后路器械矫形；术后Cobbs角为26°~75°(平均47°)，侧弯矫正率515%。患者切口Ⅰ/甲愈合。无气胸、呼吸道梗阻、肺部感染以及神经系统并发症。经6~12个月随访，植骨均已融合。无矫形度的丢失及内固定并发症；外形改善明显。[结论]经胸腔镜前路松解后路矫形一期治疗僵硬性脊柱侧弯可有效提高手术效果，有很好的安全性，减少手术次数。

    关键词：胸腔镜；脊柱畸形；脊柱侧弯

    Treatment of severe adolescent idiopathic scoliosis(AIS)by videoassisted thoracoscope to release the anteriorroute part of spine and posterior instrumented fusion(with 10 cases reported)∥LIU Limin,SONG YuemingDepartment of Orthopaedics Surgery,Huaxi Hospital,Sichuan University,Chengdu 610041

    Abstract：[Objective]To evaluate the safety and efficacy of the surgery,which was done by a videoassisted thoracoscope to release the anteriorroute part of spine and done by posterior instrumented fusion with severe Adolescent Idiopathic Scoliosis(AIS)Clinic date:There were 10 cases of AIS(King Ⅱ 6,King Ⅲ 3,King Ⅳ 1),in which there were 6 males and 4 femalesThe average age was 172 years(range 14~21)The average preoperative primary curve in the coronal plane was 913°(ranged 67°~125°)and the average pliability of thoracic spine was 283%(ranged 193%~365%)[Method]With general anesthesia(onelung ventilation or twolung ventilation),the disc complexes and part of the anterior longitudinal ligament of 5~6 disc near apex vertebra were excised under endoscopic visualizationIn the same operation,the posterior instrumented fusion was done[Result]The anterior releases under endoscopic visualization needed 120~150 min with average bleeding 157ml(ranged 100~200 ml)The thoracic draining was 100~150 ml After the posterior route surgery,the average coronal Cobbs angle was 47°(ranged 26°~75°)and the rate of rectification was 515%The patients had good fusion and outlook without other complications[Conclusion]This way,which is done by a videoassisted thoracoscope to release the anterior part of spine and done by posterior instrumented fusion has a good result about safety and efficacy ......

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