• 四川大學(xué)華西醫(yī)院骨科（成都，610041）;

【摘 要】 目的 研究前路胸腔鏡下脊柱松解聯(lián)合后路矯形術(shù)對特發(fā)性脊柱側(cè)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(lián)合后路矯形手術(shù)治療的21例IS患者肺功能進(jìn)行評估。男9例，女12例；年齡12～24歲，平均15.6歲。左側(cè)凸2例，右側(cè)凸19例。Lenke分型：Ⅰ型12例，Ⅱ型9例。發(fā)現(xiàn)脊柱側(cè)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(shù)前及術(shù)后6個月行肺功能檢測，包括肺容量、通氣功能、胸廓順應(yīng)性三部分。 結(jié)果 前路胸腔鏡下松解術(shù)中胸腔開放時間為90～150 min，平均127 min。術(shù)后切口均Ⅰ期愈合，無胸腔內(nèi)感染發(fā)生。后路矯形術(shù)完成后1周患者冠狀面Cobb角為36～75°，平均43.7°。術(shù)后患者均獲隨訪，隨訪時間6～36個月，平均13.5個月。術(shù)后6個月時，患者肺活量及最大通氣量均較術(shù)前顯著提高（P  lt; 0.05），但實測值占預(yù)計值的百分比較術(shù)前無明顯變化（P  gt; 0.05）；功能殘氣量較術(shù)前下降（P  lt; 0.05）；殘氣量實測值及與預(yù)計值的百分比均較術(shù)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(shù)前比較無明顯改善（P  gt; 0.05），最大自主通氣量較術(shù)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(shù)前顯著下降（P  lt; 0.05）。 結(jié)論 前路胸腔鏡下脊柱松解聯(lián)合后路矯形術(shù)對IS患者胸腔有一定干擾，但矯形后隨著胸腔形態(tài)變化和軟組織松解，術(shù)后早期患者肺容量、通氣功能、胸廓順應(yīng)性均得到不同程度改善，肺儲備能力提高，但遠(yuǎn)期肺功能情況仍需進(jìn)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(lián)合后路矯形對特發(fā)性脊柱側(cè)凸患者肺功能早期影響的研究. 中國修復(fù)重建外科雜志, 2012, 26(1): 70-73. doi: 復(fù)制

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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(fā)性脊柱側(cè)凸患者術(shù)后肺功能變化. 中國修復(fù)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. 1. scoliosis. Spine (Phila Pa 1976), 2011, 36(14): 1096-1102.
  2. 2. idiopathic scoliosis relative to the surgical procedure: a 10-year follow-up analysis. Spine (Phila Pa 1976), 2011, 36(20): 1665-1672.
  3. 3. spinal fusion compared with posterior spinal fusion with thoracic.
  4. 4. pedicle screws for thoracic adolescent idiopathic scoliosis. J Bone Joint Surg (Am), 2009, 91(2): 398-408.
  5. 5. in male versus female adolescent idiopathic scoliosis patients. Spine (Phila Pa 1976), 2007, 32(5): 544-549.
  6. 6. after surgical treatment of idiopathic scoliosis. Coll Antropol, 2009, 33 Suppl 2: 145-152.
  7. 7. versus open approaches. Spine (Phila Pa 1976), 2005, 30(9): 1058-1063.
  8. 8. idiopathic scoliosis. J Spinal Disord Tech, 2009, 22(8): 551-558.
  9. 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. 10. pulmonary function less than thoracotomy at 2 years postsurgery. Spine (Phlia Pa 1976), 2007, 32(4): 453-458.
  11. 11. scoliosis. Acta Orthop Belg, 2010, 76(5): 681-683.
  12. 12. in the surgical treatment of adolescent idiopathic scoliosis. J Spinal Disord Tech, 2010, 23(8): e63-69.
  13. 13. Johnston CE, Richards BS, Sucato DJ, et al. Correlation of preoperative deformity magnitude and pulmonary function tests in adolescent idiopathic.
  14. 14. Gitelman Y, Lenke LG, Bridwell KH, et al. Pulmonary function in adolescent.
  15. 15. Koumbourlis AC. Scoliosis and the respiratory system. Paediatr Respir Rev, 2006, 7(2): 152-160.
  16. 16. Lonner BS, Auerbach JD, Estreicher M, et al. Video-assisted thoracoscopic.
  17. 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. 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. 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. 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. 21. Marks M, Petcharaporn M, Betz RR, et al. Outcomes of surgical treatment.
  22. 22. Smiljani? I, Kovac V, Cimi? M. Changes in pulmonary functional parameters.
  23. 23. Faro FD, Marks MC, Newton PO, et al. Perioperative changes in pulmonary function after anterior scoliosis instrumentation: thoracoscopic.
  24. 24. Lonner BS, Auerbach JD, Estreicher MB, et al. Pulmonary function changes after various anterior approaches in the treatment of adolescent.
  25. 25. Cheung KM, LU DS, Zhang H, et al. In vivo demonstration of the effectiveness.
  26. 26. Kishan S, Bastrom T, Betz RR, et al. Thoracoscopic scoliosis surgery affects.
  27. 27. Saleh AM, Masry MA, West RM, et al. Improved pulmonary function after concave rib resection and posterior instrumentation for idiopathic.
  28. 28. 周春光, 劉立岷, 宋躍明, 等. 重度僵硬性特發(fā)性脊柱側(cè)凸患者術(shù)后肺功能變化. 中國修復(fù)重建外科雜志, 2010, 24(1): 23-26.
  29. 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. 30. Greggi T, Bakaloudis G, Fusaro I, et al. Pulmonary function after thoracoplasty.