摘要
目的 :对胸腔镜辅助前路脊柱畸形外科手术治疗的技术、结果和并发症进行统计学研究 ,用以判断该项技术在临床中的应用价值。方法 :总结 9篇胸腔镜辅助前路脊柱畸形外科手术治疗的文献 ,其中 8篇为国外研究 ,1篇为本专科研究 ,研究病例多数为青少年 ,脊柱畸形包括 :特发性脊柱侧弯、神经纤维瘤病性脊柱侧弯、先天性半椎体和胸椎后突畸形。手术技术多数采用单肺通气 ,凸侧入路 ,前路脊柱松解、骨骺阻滞或半椎体切除 ,同时再行后路矫形、植骨融合术。对手术后的结果和并发症进行统计学研究。结果 :胸腔镜辅助前路脊柱畸形外科手术时间从 90～ 2 4 0min ,住院天数平均为 9d左右 ,椎间盘切除水平 4～ 7个 ,术后Cobb角矫正率为5 5 %～ 6 3% ,平均后凸矫正达 4 4°。总并发症为 12 % ,多为呼吸系统并发症 ,无矫正度的丢失和血管神经系统并发症。结论 :胸腔镜辅助是一种微创技术 ,它能够在减少创伤的基础上完成前路脊柱畸形的松解、骨骺阻滞和半椎体切除 ,联合后路矫形能够达到满意的临床治疗效果。但需要在减少呼吸系统并发症 ,以及对侧弯的平衡、融合率、剃刀背畸形矫正 ,减轻疼痛等方面来进一步研究。
Objective:To go on a statistic analysis and review about technique、results and complication with anterior thoracoscopic assisted spine surgery in deformity , so as to evaluate clinical results with this method.Methods:A series of nine selected articles were available for review, eight came from foreign , one was our job , most series were adolescent and involved a variety of etiologies ,including idiopathic scoliosis 、neurofibroma scoliosis、congenital scoliosis、kyphosis. The surgery technique was for the most authors a convex side approach in the lateral decubitus, single lung ventilation, went on release、growth arrest and semi-vertebrae incision and the same time to stastatic analysis results and complications. Results:The total thoracoscopic procedure lasted between 90 min and 240 min , length of hospital stay was quite similar in most series and was around 9 days , the number of discs excised varied between 4 and 7 , the postoperative average Cobb angle correction was 55%～63% , kyphsis Cobb angle correction to 44°,the total complications reported were 18% , most were pulmonary complications , no vascular and nerological complications, no loss of correction. Conclusion: Thoracoscopic assisted spine surgery is an minimally invasive technique , it can get satisfactory clinical results in the treatment of spine deformity combined with posterior instrument and fusion . But to determine the real benefit of such procedures, required more the surgical outcome , including balance、rate of fusion、rib hump correction , pain and complications.
出处
《中国内镜杂志》
CSCD
2002年第9期6-9,共4页
China Journal of Endoscopy
