青少年特发性胸椎侧凸胸腔镜下矫形内固定手术的远期疗效

摘要

目的 研究胸腔镜下矫形内固定手术治疗青少年特发性胸椎侧凸( T-AIS)的远期疗效和并发症.方法 回顾性分析2002年6月至2006年12月采用胸腔镜下矫形内固定手术治疗T-AIS、随访5年以上的9例患者术前、术后3个月、2年和末次随访的X线片,测量冠状面上胸主弯和腰弯、矢状面上T5 ～ T12、T10～ L2和T12 ～S1的Cobb角.患者均为女性,手术时年龄11 ～ 16岁,平均14.3岁.记录其术后和随访时的并发症.在末次随访时采用中文版SRS-22问卷进行患者的生活质量评分.采用重复测量比较和配对t检验比较术前、术后和随访时的影像学指标.结果 随访时间5.0～7.5年,平均6.2年.患者术前胸椎侧凸Cobb角平均51°±8°,术后3个月、2年和末次随访时分别为20°±8°、21 °±12°和25 °±13 °.与术后3个月相比,术后2年和末次随访时侧凸均有矫正丢失但差异无统计学意义(P＞0.05).术后和末次随访时的腰弯Cobb角、矢状面参数变化差异无统计学意义(P＞0.05).术后2年1例患者发生断棒、1例患者发生近端Adding on现象,由于侧凸无明显加重,2例患者均未行翻修手术.末次随访时患者SRS-22总体平均分为4.3±0.3.结论 接受胸腔镜下矫形内固定手术治疗的T-AIS患者手术2年后仍可出现矫正丢失和内固定相关并发症,所以尽管手术后患者生活质量和对该手术的满意度均较高,但在选择胸腔镜下矫形内固定手术时应严格把握适应证.%Objective To study the long term outcomes and complications of video-assisted thoracoscopic surgery (VATS) in correcting thoracic adolescent idiopathic scoliosis (T-AIS) with more than five-year follow-up.Methods The T-AIS patients underwent corrective surgery by VATS between June 2002and December 2006 and experienced more than five-year follow-up were retrospectively reviewed. Nine female patients with T-AIS were recruited with a mean age of 14.3 years ( range 11-16 years) at operation.Radiological parameters including thoracic and lumbar curves, thoracic kyphosis (T5-T12), sagittal alignment of the thoracolumbar junction ( T10-L2 ) and lumbar lordosis ( T12-S1 ) were measured on the X-rays taken preoperatively,3 months,2 year postoperatively and at latest follow-up.Complications occurred after operation and during follow-up were retrieved.The Chinese edition SRS-22 was finished by patients at the latest follow-up.Repeated-measures analysis of variance and paired t test were used for statistical analysis.Results The patients were followed for a mean of 6.2 years (5-7.5 years) after VATS.The mean thoracic curve was corrected from 51 ° ± 8° preoperatively to 20° ±8° at 3 months post-operation,and 21 ° ± 12° and 25° ± 13° at 2 year post-operation and latest follow-up,respectively.During the follow-up,no significant changes were observed regarding to coronal and sagittal radiological parameters ( P ＞ 0.05 ).Rod breakage occurred in 1 patient and Adding on was found in another one patient 2 year post-operation.Revision surgery was not needed for the solid fusion achieved and lack of correction loss.The mean score of SRS-22 at final follow-up was 4.3 ±0.3,with high score in most of the domains.Conclusions Loss of curve correction and implant-related complication are found in VATS-treated T-AIS patients at the lomg-term follow-up.Although the patients show high scores in SRS-22,which indicated higher functional outcome and satisfaction to the operation,special care should be taken for applying VATS to T-AIS patients for the concern of longterm complication.