胸腔镜辅助下治疗特发性脊柱侧凸_医学论文.docVIP

胸腔镜辅助下治疗特发性脊柱侧凸_医学论文 胸腔镜辅助下治疗特发性脊柱侧凸_医学论文 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。Lenke Ⅰ型9例，术前冠状面Cobb角54°～68°，平均59.7°；Lenke Ⅲ型2例，术前冠状面Cobb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角平均20.4°，Cobb角矫正率平均65.8%；2例Lenke Ⅲ型术后Cobb角分别为20°和25°，Cobb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。 【关键词】 胸腔镜； 脊柱侧凸； 前路； 后路； 矫形； 内固定 　　Video correction of adolescent idiopathic scoliosis∥ 　　Abstract：［Objective］To evaluate clinical results of video（AIS）.［Method］Eleven cases of received video（ranged from 12 to 16 years）.There were nine cases of Lenke type Ⅰ with average preoperative Cobb（ranged from 54° to 68°）,and two cases of Lenke type Ⅲ,with average preoperative Cobb（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 Cobbrve 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,videoisted thoracoscopic anterior spinal release is a sa