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題名 | Combining Video-Assisted Thoracoscopic Release and Costoplasty in Treating Severe Idiopathic Scoliosis: A Case Report=合併胸腔鏡脊椎鬆弛與胸廓成形術治療嚴重脊柱側彎症 |
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作者 | 陳世豪; 黃聰仁; 許文蔚; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 33:2 民89.03-04 |
頁次 | 頁85-90 |
分類號 | 416.61 |
關鍵詞 | 影像胸腔鏡手術; 胸廓成形術; 脊柱側彎; Video-assisted thoracoscopic surgery; VATS; Scoliosis; Thoracoplasty; Rib hump; |
語文 | 英文(English) |
中文摘要 | 對於嚴重脊柱側彎症之矯正手術,一般須先做前位椎間盤切除、椎體間骨融合術,再輔以後位脊椎內固定器矯正及骨融合術來治療。臨床發現,側彎角度的矯正術對於肋骨駝峰畸形的回復並無絕對的相關。關於胸廓成形術之成效臨床發現,是有助於肋骨駝峰之復形,並可提供自體骨以作骨融合之用。技術上,胸廓成形術可從後背中位進行,也可由胸廓內部進行之。影像胸腔鏡脊椎手術為一新近研發之骨科手術法,我們提出的病例報告是一位13歲瘦小女孩罹患嚴重脊柱側彎併肋骨畸形,先以影像輔助之胸腔鏡施行前位手術,切除第四至十胸椎間盤,加上胸廓內成形術,以為前方椎體骨融合之用,後再加上後位骨融合、內固定術及後位胸廓成形術。此病患只使用由胸廓成形術所得之肋骨,以供前、後位手術之用,在十八個月的臨床追蹤發現骨融合處癒合佳。此項微創手術,對於嚴重脊柱側彎且合併肋骨畸形的病患,是一項另類的選擇。 |
英文摘要 | A staged operation, with anterior releases, multiple discectomies and fusion, followed by a posterior fusion and instrumentation, is recommended in treating a rigid and severe idiopathic scoliosis. Technically, correction of the lateral spinal curvature may have no effect on the rib hump prominence. Thoracoplasty, also called costoplasty, in scoliosis surgery, is recognized as a technique that might permit a reduction of rib deformity and serves as an ample source for bone grafting. Such a procedure can be accomplished via a posterior midline approach (external thoracoplasty), or from within the chest (internalthoracoplasty). Videoassisted thoracoscopic surgery (VATS) is a recently developed technique in the management of spinal disorder. Herein, we report a 13-year-old girl with a severe idiopathic scoliosis, T2 to T11 measuring 96° , andT11 to L4, 84°. The rib hump deformity was measured at 27° using a Bunnell' s scoliometer at the most prominent area. She initially underwent VATS anter-ior releases and costoplasty, followed by posterior fusion, instrumentation and external thoracoplasty. Regeneration of the ribs was seen on the 6-month postoperative radiograph. Only ribs were harvested as autogenous bone grafting without adding any iliac bone graft. At the 18-month follow-up, the rib hump deformity was measured at 5° using a Bunnell's scolio-meter. She was freely ambulatory with a good maintenance of the scoliosis correction, and solid fusion was achieved at both the thoracic and the lumbar segments. |
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