前路胸腔镜下青少年特发性胸椎侧凸矫形的初步临床结果

目的回顾胸腔镜下青少年特发性脊柱侧凸（adolecent idiopathic scoliosis,AIS）前路矫形的初步临床疗效。方法 2007年8月~2008年11月行胸腔镜下前路矫形患者8例,均为女性Lenkel A-型AIS患者,平均年龄为13.8岁。对手术前后及末次随访时的胸椎侧凸Cobb角、腰椎侧凸Cobb角、顶椎中点与C7中点垂线或骶骨平分线垂直距离（apical vertebral translation,AVT）、顶椎旋转角、胸椎后凸Cobb角及双肩高度差进行分析。结果所有患者术后随访3~12个月,胸椎侧凸Cobb角平均改善率为71%、矫形丢失率为6%;腰椎侧凸Cobb角平均改善率为60%、矫形丢失率为6%;AVT改善率为73%,丢失率为6%。所有患者顶椎旋转角度均无改善;胸椎后凸Cobb角无改变。双肩高度差除1例患者随访时丢失50%,其余改善率均为100%。结论柔韧度好的Lenkel A-型AIS行胸腔镜下前路矫形可获得良好的冠状面矫形,但矢状面矫形及椎体去旋转效果不佳,长期疗效有待继续观察。

Preliminary clinical results of thoracoscopic assisted anterior surgery for adolecent idiopathic scoliosis

Objective To review the preliminary clinical results of thoracoscopic assisted anterior surgery for adolecent idiopathic scoliosis(AIS).Methods From August 2007 to November 2008, 8 AIS patients underwent thoracoscopic assisted anterior surgery. All the 8 cases were female with Lenkel A-type AIS. The average age was 13.8 years. The early results were assessed including thoracic scoliosis Cobb's angle, lumbar scoliosis Cobb's angle, apical vertebral translation(AVT), apical vertebra rotating angle, thoracic kyphosis Cobb's angle and shoulder height difference. Results The follow-up ranged from 3 to 12 months.The average thoracic scoliosis correction rate was 71%, the loss rate was 6%. The lumbar scoliosis correction rate was 60%, the loss rate was 6%. AVT correction rate was 73%, the loss rate was 6%. Apical vertebra rotating angle and thoracic kyphosis Cobb's angle had no correction in all the cases. Shoulder height difference correction rate was 100% in all the cases expected 1 case loss for 50%.Conclusion Thoracoscopic assisted anterior surgery for Lenkel A-type AIS can get good correction in coronal plane, but less correction in sagittal and transverse planes.Its long trem results need more clincal study.