前路胸腔鏡下松解聯合后路矯形對特發性脊柱側凸患者肺功能早期影響的研究_《中國修復重建外科雜志》

作者：

劉立岷 , 宋躍明 , 周忠杰 , 李倩 , 周春光

四川大學華西醫院骨科（成都，610041）;

關鍵詞：

胸腔鏡特發性脊柱側凸肺功能

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【摘要】目的研究前路胸腔鏡下脊柱松解聯合后路矯形術對特發性脊柱側凸（idiopathic scoliosis，IS）患者肺功能早期影響。方法對2004年4月－2008年6月行前路胸腔鏡下松解聯合后路矯形手術治療的21例IS患者肺功能進行評估。男9例，女12例；年齡12～24歲，平均15.6歲。左側凸2例，右側凸19例。Lenke分型：Ⅰ型12例，Ⅱ型9例。發現脊柱側凸1年6個月～9年，平均2.5年。胸椎冠狀面Cobb角為65～125°，平均為79.6°。于術前及術后6個月行肺功能檢測，包括肺容量、通氣功能、胸廓順應性三部分。結果前路胸腔鏡下松解術中胸腔開放時間為90～150 min，平均127 min。術后切口均Ⅰ期愈合，無胸腔內感染發生。后路矯形術完成后1周患者冠狀面Cobb角為36～75°，平均43.7°。術后患者均獲隨訪，隨訪時間6～36個月，平均13.5個月。術后6個月時，患者肺活量及最大通氣量均較術前顯著提高（P lt; 0.05），但實測值占預計值的百分比較術前無明顯變化（P gt; 0.05）；功能殘氣量較術前下降（P lt; 0.05）；殘氣量實測值及與預計值的百分比均較術前下降（P lt; 0.05）。第1秒用力呼氣肺活量及其與用力呼氣肺活量比值與術前比較無明顯改善（P gt; 0.05），最大自主通氣量較術前顯著上升（P lt; 0.05）。患者總氣道阻力、吸入氣道阻力及呼出氣道阻力均較術前顯著下降（P lt; 0.05）。結論前路胸腔鏡下脊柱松解聯合后路矯形術對IS患者胸腔有一定干擾，但矯形后隨著胸腔形態變化和軟組織松解，術后早期患者肺容量、通氣功能、胸廓順應性均得到不同程度改善，肺儲備能力提高，但遠期肺功能情況仍需進一步觀察。

引用本文： 劉立岷,宋躍明,周忠杰,李倩,周春光. 前路胸腔鏡下松解聯合后路矯形對特發性脊柱側凸患者肺功能早期影響的研究. 中國修復重建外科雜志, 2012, 26(1): 70-73. doi: 復制

1.	scoliosis. Spine (Phila Pa 1976), 2011, 36(14): 1096-1102.
2.	idiopathic scoliosis relative to the surgical procedure: a 10-year follow-up analysis. Spine (Phila Pa 1976), 2011, 36(20): 1665-1672.
3.	spinal fusion compared with posterior spinal fusion with thoracic.
4.	pedicle screws for thoracic adolescent idiopathic scoliosis. J Bone Joint Surg (Am), 2009, 91(2): 398-408.
5.	in male versus female adolescent idiopathic scoliosis patients. Spine (Phila Pa 1976), 2007, 32(5): 544-549.
6.	after surgical treatment of idiopathic scoliosis. Coll Antropol, 2009, 33 Suppl 2: 145-152.
7.	versus open approaches. Spine (Phila Pa 1976), 2005, 30(9): 1058-1063.
8.	idiopathic scoliosis. J Spinal Disord Tech, 2009, 22(8): 551-558.
9.	of thoracoscopic anterior release using the fulcrum-bending radiograph: a report of five cases. Eur Spine J, 2006, 15 Suppl 5: 578-582.
10.	pulmonary function less than thoracotomy at 2 years postsurgery. Spine (Phlia Pa 1976), 2007, 32(4): 453-458.
11.	scoliosis. Acta Orthop Belg, 2010, 76(5): 681-683.
12.	in the surgical treatment of adolescent idiopathic scoliosis. J Spinal Disord Tech, 2010, 23(8): e63-69.
13.	Johnston CE, Richards BS, Sucato DJ, et al. Correlation of preoperative deformity magnitude and pulmonary function tests in adolescent idiopathic.
14.	Gitelman Y, Lenke LG, Bridwell KH, et al. Pulmonary function in adolescent.
15.	Koumbourlis AC. Scoliosis and the respiratory system. Paediatr Respir Rev, 2006, 7(2): 152-160.
16.	Lonner BS, Auerbach JD, Estreicher M, et al. Video-assisted thoracoscopic.
17.	Newton PO, Upasani VV, Lhamby J, et al. Surgical treatment of main thoracic scoliosis with thoracoscopic anterior instrumentation. J Bone Joint Surg (Am), 2009, 91 Suppl 2: 233-248.
18.	Sucato DJ, Erken YH, Davis S, et al. Prone thoracoscopic release does not adversely affect pulmonary function when added to a posterior spinal fusion for severe spine deformity. Spine (Phlia Pa 1976), 2009, 34(8): 771-778.
19.	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 spinal arthrodesis. Spine (Phlia Pa 1976), 2000, 25(1): 82-90.
20.	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.
21.	Marks M, Petcharaporn M, Betz RR, et al. Outcomes of surgical treatment.
22.	Smiljani? I, Kovac V, Cimi? M. Changes in pulmonary functional parameters.
23.	Faro FD, Marks MC, Newton PO, et al. Perioperative changes in pulmonary function after anterior scoliosis instrumentation: thoracoscopic.
24.	Lonner BS, Auerbach JD, Estreicher MB, et al. Pulmonary function changes after various anterior approaches in the treatment of adolescent.
25.	Cheung KM, LU DS, Zhang H, et al. In vivo demonstration of the effectiveness.
26.	Kishan S, Bastrom T, Betz RR, et al. Thoracoscopic scoliosis surgery affects.
27.	Saleh AM, Masry MA, West RM, et al. Improved pulmonary function after concave rib resection and posterior instrumentation for idiopathic.
28.	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.
29.	Verma K, Lonner BS, Kean KE, et al. Maximal pulmonary recovery after spinal fusion for adolescent idiopathic scoliosis: how do anterior approaches compare? Spine (Phlia Pa 1976), 2011, 36(14): 1086-1095.
30.	Greggi T, Bakaloudis G, Fusaro I, et al. Pulmonary function after thoracoplasty.

1. scoliosis. Spine (Phila Pa 1976), 2011, 36(14): 1096-1102.
2. idiopathic scoliosis relative to the surgical procedure: a 10-year follow-up analysis. Spine (Phila Pa 1976), 2011, 36(20): 1665-1672.
3. spinal fusion compared with posterior spinal fusion with thoracic.
4. pedicle screws for thoracic adolescent idiopathic scoliosis. J Bone Joint Surg (Am), 2009, 91(2): 398-408.
5. in male versus female adolescent idiopathic scoliosis patients. Spine (Phila Pa 1976), 2007, 32(5): 544-549.
6. after surgical treatment of idiopathic scoliosis. Coll Antropol, 2009, 33 Suppl 2: 145-152.
7. versus open approaches. Spine (Phila Pa 1976), 2005, 30(9): 1058-1063.
8. idiopathic scoliosis. J Spinal Disord Tech, 2009, 22(8): 551-558.
9. of thoracoscopic anterior release using the fulcrum-bending radiograph: a report of five cases. Eur Spine J, 2006, 15 Suppl 5: 578-582.
10. pulmonary function less than thoracotomy at 2 years postsurgery. Spine (Phlia Pa 1976), 2007, 32(4): 453-458.
11. scoliosis. Acta Orthop Belg, 2010, 76(5): 681-683.
12. in the surgical treatment of adolescent idiopathic scoliosis. J Spinal Disord Tech, 2010, 23(8): e63-69.
13. Johnston CE, Richards BS, Sucato DJ, et al. Correlation of preoperative deformity magnitude and pulmonary function tests in adolescent idiopathic.
14. Gitelman Y, Lenke LG, Bridwell KH, et al. Pulmonary function in adolescent.
15. Koumbourlis AC. Scoliosis and the respiratory system. Paediatr Respir Rev, 2006, 7(2): 152-160.
16. Lonner BS, Auerbach JD, Estreicher M, et al. Video-assisted thoracoscopic.
17. Newton PO, Upasani VV, Lhamby J, et al. Surgical treatment of main thoracic scoliosis with thoracoscopic anterior instrumentation. J Bone Joint Surg (Am), 2009, 91 Suppl 2: 233-248.
18. Sucato DJ, Erken YH, Davis S, et al. Prone thoracoscopic release does not adversely affect pulmonary function when added to a posterior spinal fusion for severe spine deformity. Spine (Phlia Pa 1976), 2009, 34(8): 771-778.
19. 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 spinal arthrodesis. Spine (Phlia Pa 1976), 2000, 25(1): 82-90.
20. 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.
21. Marks M, Petcharaporn M, Betz RR, et al. Outcomes of surgical treatment.
22. Smiljani? I, Kovac V, Cimi? M. Changes in pulmonary functional parameters.
23. Faro FD, Marks MC, Newton PO, et al. Perioperative changes in pulmonary function after anterior scoliosis instrumentation: thoracoscopic.
24. Lonner BS, Auerbach JD, Estreicher MB, et al. Pulmonary function changes after various anterior approaches in the treatment of adolescent.
25. Cheung KM, LU DS, Zhang H, et al. In vivo demonstration of the effectiveness.
26. Kishan S, Bastrom T, Betz RR, et al. Thoracoscopic scoliosis surgery affects.
27. Saleh AM, Masry MA, West RM, et al. Improved pulmonary function after concave rib resection and posterior instrumentation for idiopathic.
28. 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.
29. Verma K, Lonner BS, Kean KE, et al. Maximal pulmonary recovery after spinal fusion for adolescent idiopathic scoliosis: how do anterior approaches compare? Spine (Phlia Pa 1976), 2011, 36(14): 1086-1095.
30. Greggi T, Bakaloudis G, Fusaro I, et al. Pulmonary function after thoracoplasty.

《中國修復重建外科雜志》

前路胸腔鏡下松解聯合后路矯形對特發性脊柱側凸患者肺功能早期影響的研究

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《中國修復重建外科雜志》

前路胸腔鏡下松解聯合后路矯形對特發性脊柱側凸患者肺功能早期影響的研究

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