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目的介绍特发性胸椎侧凸胸腔镜辅助小切口前路矫形手术的技术要点和手术适应证选择,并对其临床结果进行分析。方法2001年7月至2006年1月共进行胸椎侧凸小切口前路矫形手术37例,男4例,女33例,平均年龄14.1岁,冠状面Cobb角平均56°,Lenke分型ⅠA 14例,ⅠB 14例,ⅠC 9例,均为胸椎右侧凸,Risser征++～++++,对手术时间、术中出血量、固定节段、矫正效果以及矫正丢失等进行分析。结果平均手术时间220 min,术中出血量平均320 ml,平均固定节段7.8个,术后Cobb角平均16.8°,平均侧凸矫正率70%,随访18～36个月,平均矫正丢失4.6%,无内固定并发症发生。结论胸椎侧凸前路胸腔镜辅助小切口矫形手术在减少手术创伤、降低麻醉要求、相对胸腔镜手术更为宽松的适应证选择基础上,可以达到传统开胸前路矫形或后路矫形手术的临床效果、且没有增加手术并发症。
Objective To introduce the technical points and the choice of surgical indications for idiopathic thoracic auxiliary thoracoscopic assisted small incision anterior surgery and to analyze the clinical results. Methods From July 2001 to January 2006, 37 cases of anterior correction of thoracic scoliosis were performed. There were 4 males and 33 females, with an average age of 14.1 years. The coronal Cobb angle was 56 ° on average, Lenke’s classification ⅠA 14 Cases, Ⅰ B 14 cases, Ⅰ C 9 cases, all right thoracic convex, Risser sign ++ ~ ++++, the operation time, intraoperative blood loss, fixed segments, the effect of correction and correction loss were analyzed. Results The mean operative time was 220 min. The mean blood loss during operation was 320 ml. The average number of fixed segments was 7.8. The average Cobb angle was 16.8 °. The average correction rate was 70%. The follow-up was 18-36 months. The average correction loss was 4.6% , No complications of internal fixation. Conclusions Thoracic anterior thoracoscopic assisted small incision orthopedic surgery can reduce the surgical trauma, reduce the anesthesia requirements, the relative ease of laparoscopic surgery indications based on selection, you can reach the traditional open-chest orthopedic or posterior orthopedic surgery Clinical effect, and did not increase the surgical complications.