胸椎侧凸后路凸侧胸廓成形术后胸腔并发症及其预防.pdfVIP

中国骨伤2008年4月第21卷第4期 China J Orthop＆Trauma，Apr．2008，Vo1．21，No．4 · 249· · 临 床 研 究 · 胸椎侧凸后路凸侧胸廓成形术后胸腔并发症及其 预防 朱泽章，邱勇，王斌，俞杨，钱邦平，朱锋 (南京大学医学院附属鼓楼医院脊柱外科，江苏 南京 210008) 【摘要】 目的：探讨青少年特发性胸椎侧凸后路凸侧胸廓成形术的胸腔并发症原因，并提出预防措施。方法：对 2003年 l2月至2007年9月行脊柱侧凸后路矫形内固定术和凸侧胸廓成形术，并有完整资料的胸椎侧凸患者548例 进行回顾性分析。其中男167例，女381例；年龄12-38岁，平均l6．1岁。术前剃刀背畸形l6。～50。。平均35。。结果：凸 侧胸廓成形的肋骨切除数平均4．1根。术后剃刀背畸形2。～l7。，平均7。。l例(0．2％)术后呼吸困难需间歇性吸氧。29例 (5．3％)术中发生壁层胸膜穿孔，其中5例术后胸腔积液，3例气胸。6例(1．1％)患者术中并无明显胸膜穿孔．但术后出 现术侧胸腔积液。结论：提高手术技巧，术后严密监测呼吸状态，早期积极处理，可减少凸侧胸廓成形术后胸腔并发症 的发生。 【关键词】 脊柱侧凸；胸椎； 胸廓成形术； 手术中并发症； 手术后并发症； Thoracic complications of convex thoracoplasty in patients with thoracic scoHosis ZHU Ze-zhang，QIU Yong，WANG Bin，YU Yang，QIAN Bang-ping，ZHU Feng．Department ofst,ine Surgery。Gulou Hospital Affiliated ofMedical College of NanjingUniversity，Nanjing 210008，Jiangsu，China ABSTRACT Objective：To analyze thoracic complications related to the convex thoracoplasty for the treatment of rib hump deformity in patients with thoracic scoliosis．Methods：Between December 2003 and Septemb er 2007，548 patients with tho- racic scoliosis underwent posterior spinal correction and the convex thoracoplasty．There were 167 male and 381 female，with an average age of 16．1 years(range，12to 38 years)．The mean preoperative rib prominence was 35。(range，16。to 50。)．Resu- its：The mean number of resected ribs was 4．1．The mean rib prominence was 7。(range 2。to 17。)after operation．No death happened．Thoracic complications related to the thoracoplasty consisted of respiratory insufficiency in 1(0．2％)raop- erative tear ofparietal pleura in 29(5．3％)，with a subsequent pleural effusion in 6 and pneumothorax in 3．In the other patien- ts，no obvioustearofparietalpleurawasf0undduring operation．However，6(1．1％)patients hadpleural effusion after operati- on．Conclusion：The thora