胸椎侧凸后路凸侧胸廓成形术后胸腔并发症及其预防

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12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16.1岁。术前剃刀背畸形16°～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°～17°,平均7°。1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。

Thoracic complications of convex thoracoplasty in patients with thoracic scoliosis

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 September 2007,548 patients with thoracic 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,12 to 38 years). The mean preoperative rib prominence was 35°(range,16° to 50°). Results: 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%)patient,intraop- erative tear of parietal pleura in 29(5.3%),with a subsequent pleural effusion in 6 and pneumothorax in 3. In the other patien- ts,no obvious tear of parietal pleura was found during operation. However,6(1.1%) patients had pleural effusion after operati -on. Conclusion: The thoracic complications related to convex thoracoplasty can be decreased by improving the surgical skill and using respiratory function monitoring.