保留肋骨经肋间隙入路在中下胸椎手术中的应用研究

目的：探讨保留肋骨经肋间隙入路在中下胸椎手术中的应用价值。方法对40例中下胸椎疾病患者采用保留并不断肋骨经肋间隙入路进行手术（A组），并与采用传统后外侧断肋入路进行手术（B组）的40例患者进行比较，观察两组在切口长度、手术视野纵向直径、开胸时间、关胸时间、胸内操作时间、术中出血量、引流管放置时间、术后引流量、术后疼痛视觉模拟评分（VAS）、术前和术后1周呼吸功能及术后住院时间等各项指标的差异。结果A组手术切口长度、开胸时间、关胸时间、术中出血量、引流管放置时间、术后引流量、术后住院时间均优于B组，差异均有统计学意义（P＜0.05）。A组术后1月的疼痛VAS评分优于B组，差异有统计学意义（P＜0.05），但术后3个月的疼痛VAS评分两组差异无统计学意义（P＞0.05）。两组术前肺功能评分比较差异无统计学意义（P＞0.05）。A组术后1周的肺功能评分优于B组，差异有统计学意义（P＜0.05）。两组在手术视野纵向直径、胸内操作时间比较差异均无统计学意义（P＞0.05）。结论采用保留肋骨经肋间隙入路治疗胸椎疾病，具有进胸快、手术视野暴露充分、出血量少、关胸简便、术后疼痛轻、恢复快、生活质量高等优点，有推广价值。

Application research on the ribs-reserved intercostal space approach for the middle and lower thoracic verte-brae surgery

Objective To investigate the value of the ribs-reserved intercostal space approach in the middle and lower thoracic vertebrae surgery .Methods The operation via intercostal space without breaking the ribs were performed on 40 patients with the middle and lower thoracic vertebrae disease （group A）, and compared with the con-trol group which contained 40 cases accepting the traditional lateral ribs-broken methods（group B）.The difference between the two groups were compared in the operative incision length , vertical diameter of the surgical field , thora-cotomy time, thoracic operation time , time of closing thoracic incision , peri-operative bleeding volume , placement time of drainage tube, postoperative drainage, postoperative pain visual analogue scale （VAS）, respiratory function before operation and at one week after operation as well as postoperative hospitalization duration .Results The results of group A were superior to the group B in incision length , thoracotomy time , time of closing thoracic incision , blood loss, placement time of drainage tube , postoperative drainage and postoperative hospitalization duration （ P〈0.05 ）;VAS score of one month after the operation of group A was better than that of group B , the difference was statistically significant（P〈0.05）.However, there was no significant difference of 3 months after operation（P〉0.05）;preoper-ative lung function scores between the two groups showed no difference （ P〉0.05 ） , but the lung function at one week after operation of group A was better than that of group B （ P〈0.05 ）;The outcomes between the two groups showed no difference in the fields of surgical field longitudinal diameter and operating time （ P〉0.05 ） .Conclusion The application of the ribs-reserved intercostal space approach for the treatment of thoracic vertebrae disease has the ad -vantage of being able to save time , exposing operative field fully , curbing the bleeding , making simple incision , cau-sing less postoperative pain ,