凸側短段肋骨切除術后肋骨再生的臨床觀察_《中國修復重建外科雜志》

作者：

周春光 , 宋躍明 , 龔全 , 李濤 , 曾建成 , 孔清泉 , 劉浩 , 劉立岷

四川大學華西醫院骨科（成都，610041）;

關鍵詞：

青少年特發性脊柱側凸胸廓成形術肋骨切除術肋骨再生

DOI：

10.7507/1002-1892.20130179

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目的比較青少年特發性脊柱側凸行凸側短段肋骨切除術及常規胸廓成形術后肋骨再生情況。方法回顧分析2005年1月－2009年12月采用單純后路矯形內固定融合術治療的Lenke l型青少年特發性脊柱側凸患者臨床資料，其中36例隨訪資料完整，根據采用的胸廓成形術分為常規胸廓成形術組（A組14例）和凸側短段肋骨切除術組（B組22例）。兩組患者性別、年齡、主彎Cobb角、柔韌度、術前剃刀背高度等一般資料比較，差異均無統計學意義（P gt; 0.05），具有可比性。術后3、6個月及1、2年攝全脊柱正側位X線片，采用Philips等提出的肋骨再生分級標準對患者肋骨再生情況進行評估。結果兩組患者均獲隨訪，隨訪時間24～48個月，平均32個月。兩組主彎Cobb角及剃刀背高度均較術前顯著改善（P lt; 0.05），且無明顯矯正丟失；術后各時間點，兩組主彎Cobb角差異無統計學意義（P gt; 0.05），剃刀背高度B組顯著大于A組（P lt; 0.05）。術后各時間點B組肋骨再生情況均明顯優于A組，差異有統計學意義（P lt; 0.05）。術后3個月，A組中80.0%的肋骨尚處于再生4級以下（不包括4級），而B組中96.3%的肋骨處于再生4級及以上；術后2年，A組僅52.0%的肋骨再生處于6級及以上，而B組中96.3%的肋骨再生處于6級及以上。結論凸側短段肋骨切除術后肋骨再生情況優于常規胸廓成形術。

引用本文： 周春光,宋躍明,龔全,李濤,曾建成,孔清泉,劉浩,劉立岷. 凸側短段肋骨切除術后肋骨再生的臨床觀察. 中國修復重建外科雜志, 2013, 27(7): 814-818. doi: 10.7507/1002-1892.20130179 復制

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11.	Philip SJ, Kumar RJ, Menon KV. Morphological study of rib regeneration following costectomy in adolescent idiopathic scoliosis. Eur Spine J, 2005, 14(8): 772-776．.
12.	夏才偉, 邱勇, 王斌, 等. 青少年特發性胸椎側凸胸廓成形術后肋骨自然再生的觀察. 中國脊柱脊髓雜志, 2007, 17(4): 266-269.
13.	Chen SH, Huang TJ, Lee YY, et al. Pulmonary function after thoracoplasty in adolescent idiopathic scoliosis. Clin Orthop Relat Res, 2002, (399): 152-161.
14.	Vedantam R, Lenke LG, Bridwell KH, et al. A prospective evaluation of pulmonary function in patients with adolescent idiopathic scoliosis relative to the surgical approach used for the spinal arthrodesis. Spine (Phila Pa 1976), 2000, 25(1): 82-90.
15.	Kim YJ, Lenke LG, Bridwell KH, et al. Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure. J Bone Joint Surg (Am), 2005, 87(7): 1534-1541.
16.	Yaszay B, Jazayeri R, Lonner B. The effect of surgical approaches on pulmonary function in adolescent idiopathic scoliosis. J Spinal Disord Tech, 2009, 22(4): 278-283.
17.	Takahashi S, Suzuki N, Asazuma T, et al. Factors of thoracic cage deformity that affect pulmonary function in adolescent idiopathic thoracic scoliosis. Spine (Phila Pa 1976), 2007, 32(1): 106-112.
18.	Newton PO, Perry A, Bastrom TP, et al. Predictors of change in postoperative pulmonary function in adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2007, 32(17): 1875-1882.
19.	周春光, 劉立岷, 宋躍明, 等. 重度僵硬性特發性脊柱側凸患者術后肺功能變化. 中國修復重建外科雜志, 2010, 24(1): 23-26.

1. Steel HH. Rib resection and spine fusion in correction of convex deformity in scoliosis. J Bone Joint Surg (Am), 1983, 65(7): 920-925.
2. Barrett DS, MacLean JG, Bettany J, et al. Costoplasty in adolescent idiopathic scoliosis: objective results in 55 patients. J Bone Joint Surg (Br), 1993, 75(6): 881-885.
3. Geissele AE, Ogilvie JW, Cohen M, et al. Thoracoplasty for the treatment of rib prominence in thoracic scoliosis. Spine (Phila Pa 1976), 1994, 19(14): 1636-1642.
4. Harvey CJ, Betz RR, Huss GK, et al. Are there indications for partial rib resection in adolescent idiopathic scoliosis patients treated with Cotrel-Dubosset instrumentation? Spine (Phila Pa 1976), 1993, 18(12): 1593-1598.
5. Suk SI, Kim JH, Kim SS, et al. Thoracoplasty in thoracic adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2008, 33(10): 1061-1067.
6. Min K, Waelchli B, Hahn F. Primary thoracoplasty and pedicle screw instrumentation in thoracic idiopathic scoliosis. Eur Spine J, 2005, 14(8): 777-782.
7. Kostamo T, Choit R, Sawatzky B, et al. Thoracoplasty in adolescent idiopathic scoliosis: a critical appraisal. J Bone Joint Surg (Br), 2008, 90-B(Supp I): 116.
8. Harding IJ, Chopin D, Charosky S, et al. Long-term results of Schollner costoplasty in patients with idiopathic scoliosis. Spine (Phila Pa 1976), 2005, 30(14): 1627-1631.
9. Chunguang Z, Yueming S, Limin L, et al. Convex short length rib resection in thoracic adolescent idiopathic scoliosis. J Pediatr Orthop, 2011, 31(7): 757-763.
10. 朱澤章, 邱勇, 王斌, 等. 青少年特發性胸椎側凸后路凸側胸廓成形術的并發癥分析. 中國脊柱脊髓雜志, 2007, 17(8): 579-583.
11. Philip SJ, Kumar RJ, Menon KV. Morphological study of rib regeneration following costectomy in adolescent idiopathic scoliosis. Eur Spine J, 2005, 14(8): 772-776．.
12. 夏才偉, 邱勇, 王斌, 等. 青少年特發性胸椎側凸胸廓成形術后肋骨自然再生的觀察. 中國脊柱脊髓雜志, 2007, 17(4): 266-269.
13. Chen SH, Huang TJ, Lee YY, et al. Pulmonary function after thoracoplasty in adolescent idiopathic scoliosis. Clin Orthop Relat Res, 2002, (399): 152-161.
14. Vedantam R, Lenke LG, Bridwell KH, et al. A prospective evaluation of pulmonary function in patients with adolescent idiopathic scoliosis relative to the surgical approach used for the spinal arthrodesis. Spine (Phila Pa 1976), 2000, 25(1): 82-90.
15. Kim YJ, Lenke LG, Bridwell KH, et al. Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure. J Bone Joint Surg (Am), 2005, 87(7): 1534-1541.
16. Yaszay B, Jazayeri R, Lonner B. The effect of surgical approaches on pulmonary function in adolescent idiopathic scoliosis. J Spinal Disord Tech, 2009, 22(4): 278-283.
17. Takahashi S, Suzuki N, Asazuma T, et al. Factors of thoracic cage deformity that affect pulmonary function in adolescent idiopathic thoracic scoliosis. Spine (Phila Pa 1976), 2007, 32(1): 106-112.
18. Newton PO, Perry A, Bastrom TP, et al. Predictors of change in postoperative pulmonary function in adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2007, 32(17): 1875-1882.
19. 周春光, 劉立岷, 宋躍明, 等. 重度僵硬性特發性脊柱側凸患者術后肺功能變化. 中國修復重建外科雜志, 2010, 24(1): 23-26.

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凸側短段肋骨切除術后肋骨再生的臨床觀察

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《中國修復重建外科雜志》

凸側短段肋骨切除術后肋骨再生的臨床觀察

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