【摘 要】
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目的：探讨凸侧短段肋骨切除术在青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)矫形中的作用.方法：对66例采用后路全椎弓根螺钉矫形的AIS患者进行回顾性分析,根据是否进行凸侧短段肋骨切除术分为两组：A组,凸侧短段肋骨切除术组,行后路全椎弓根螺钉侧凸矫形术及凸侧短段肋骨切除术；B组,对照组,单纯进行后路全椎弓根螺钉侧凸矫形术.所有病人随访1年以上,术前及
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目的：探讨凸侧短段肋骨切除术在青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)矫形中的作用.方法：对66例采用后路全椎弓根螺钉矫形的AIS患者进行回顾性分析,根据是否进行凸侧短段肋骨切除术分为两组：A组,凸侧短段肋骨切除术组,行后路全椎弓根螺钉侧凸矫形术及凸侧短段肋骨切除术；B组,对照组,单纯进行后路全椎弓根螺钉侧凸矫形术.所有病人随访1年以上,术前及术后1年时测量剃刀背高度、拍摄全脊柱正侧位X片,术前、术后3月及1年时测定肺功能.在全脊柱正侧位X片上测量侧凸的Cobb角、冠状面平衡、矢状面平衡、胸椎后凸Cobb角、腰椎前凸Cobb角.肺功能检查选择用力肺活量(forced vital capacity,FVC)和第1秒用力呼气容积(forced expiratory volume in 1 second,FEV1.0)作为观察指标,分别记录实测值及实测值占预计值的百分比.所有数据以均数±标准差表示,采用SPSS17.0对所有数据进行组间比较.结果：A组中,切除凸侧肋骨3～6根,平均4.2±0.9根；有2例患者术后出现胸壁疼痛,经对症处理后缓解,其余患者无并发症.两组病人的年龄、性别、侧凸类型均无明显差异.两组病人术前的剃刀背高度、侧凸Cobb角、冠状面平衡、矢状面平衡、胸椎后凸Cobb角、腰椎前凸Cobb角均无明显差异,术后1年,A组病人的剃刀背高度为16.0±6.3mm,明显低于B组(27.8±9.1mm,P＜0.05),剃刀背畸形矫正率为63.5％±5.4％,明显高于B组(P＜0.05),胸椎后凸Cobb角为27.8°±8.2°,优于B组(P＜0.05),其余各项指标两组间未见明显差异(P＞0.05).术前FVC、FEV1.0在两组间无明显差异(P＞0.05),A组中,凸侧短段肋骨切除术后3月及1年的FVC、FEV1.0与术前相比无明显差异(P＞0.05),术后3月及1年,FVC、FEV1.0在两组间无明显差异(P＞0.05).结论：凸侧短段肋骨切除术可有效矫正AIS患者剃刀背畸形,提高矢状面畸形矫正率,矫形效果满意,并发症少.
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