Khan I H, McManus K G, McCraith A, McGuigan J A
Northern Ireland Regional Thoracic Surgical Unit, Royal Victoria Hospital, Grosvenor Road, BT12 6BA, Belfast, UK.
Eur J Cardiothorac Surg. 2000 Dec;18(6):656-61. doi: 10.1016/s1010-7940(00)00591-1.
This study compares the posterior auscultatory triangle thoracotomy incision (muscle sparing) with full posterolateral thoracotomy (where latissimus dorsi muscle is always cut across its full width), with particular attention to the difference between latissimus dorsi muscle strength, post operative pain and chronic wound related symptoms.
Ten patients who had undergone auscultatory triangle thoracotomy (ATT) at least 1 year previously were matched with ten patients who had undergone posterolateral thoracotomy (PLT). Each pair was matched for age, sex, dominant hand, side of the operation, time since operation and presence or absence of history of previous muscle training. Latissimus dorsi muscle strength was assessed by testing the shoulder adduction strength through an arc of 90-0 degrees using isokinetic technique. Early post-operative pain was assessed indirectly by calculating the analgesic requirement in the first 5 post-operative days. A subjective assessment of chronic post-thoracotomy pain was made using a questionnaire presented to the patients at the time of muscle testing. Variability of the torque curves, recorded as coefficient of variance at the time of muscle strength testing, provided objective measurements of chronic pain. Data were analysed using two sample t-tests.
All patients reported at least one chronic post-thoracotomy symptom. There was no significant difference between the two groups in terms of acute or chronic wound pain and other long term wound related symptoms. Shoulder adduction strength was 24% greater in ATT than PLT (95% confidence limits=1-43%, P=0.04).
All thoracotomy patients have long term wound related symptoms. This situation is not improved by performing a muscle sparing incision. However thoracotomy through the triangle of auscultation can preserve latissimus dorsi strength which is compromised in a posterolateral thoracotomy incision. We therefore recommend that a muscle sparing thoracotomy be considered for patients where preservation of muscle strength is deemed important, providing the operation is not compromised due to inadequate access.
本研究比较后听诊三角开胸切口（保留肌肉）与全后外侧开胸切口（背阔肌总是被完全横断），特别关注背阔肌力量、术后疼痛和慢性伤口相关症状之间的差异。
选取至少1年前接受过听诊三角开胸术（ATT）的10例患者与接受过后外侧开胸术（PLT）的10例患者进行匹配。每对患者在年龄、性别、优势手、手术侧、术后时间以及有无既往肌肉训练史方面进行匹配。采用等速技术通过测试90 - 0度弧内的肩内收力量来评估背阔肌力量。通过计算术后前5天的镇痛需求量间接评估早期术后疼痛。在肌肉测试时向患者发放问卷，对慢性开胸术后疼痛进行主观评估。在肌肉力量测试时记录的扭矩曲线变异系数提供了慢性疼痛的客观测量值。数据采用两样本t检验进行分析。
所有患者均报告至少一种慢性开胸术后症状。两组在急性或慢性伤口疼痛及其他长期伤口相关症状方面无显著差异。ATT组的肩内收力量比PLT组大24%（95%置信区间 = 1 - 43%，P = 0.04）。
所有开胸手术患者都有长期的伤口相关症状。采用保留肌肉的切口并不能改善这种情况。然而，通过听诊三角进行开胸手术可以保留背阔肌力量，而后外侧开胸切口会损害该力量。因此，我们建议对于认为保留肌肉力量很重要的患者，考虑采用保留肌肉的开胸手术，前提是手术不会因入路不足而受到影响。
