胸腔镜辅助下手术治疗特发性脊柱侧凸：学习曲线评估

Video-assisted thoracoscopic surgery in idiopathic scoliosis: evaluation of the learning curve.

作者信息

Son-Hing Jochen P, Blakemore Laurel C, Poe-Kochert Connie, Thompson George H

机构信息

Division of Pediatric Orthopedics, Rainbow Babies and Children's Hospital, Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA.

出版信息

Spine (Phila Pa 1976). 2007 Mar 15;32(6):703-7. doi: 10.1097/01.brs.0000257528.89699.b1.

DOI:10.1097/01.brs.0000257528.89699.b1

PMID:17413478

Abstract

STUDY DESIGN

Retrospective review of patients with idiopathic scoliosis who underwent same-day or staged anterior and posterior spinal fusion and segmental spinal instrumentation.

OBJECTIVE

Evaluation of our learning curve with video-assisted thoracoscopic surgery (VATS) with respect to operative time, blood loss, and complications in patients with idiopathic scoliosis.

SUMMARY OF BACKGROUND DATA

VATS is a minimally invasive alternative to thoracotomy in the management of idiopathic scoliosis. An increased or steep learning curve has been described in the initial application of this technique.

METHODS

We began performing VATS in 1998. We compared our first 25 consecutive VATS patients (Group 2) and subsequent 28 consecutive VATS patients (Group 3) to our previous 16 consecutive patients (Group 1) with a thoracotomy (1991-1998) for idiopathic scoliosis. Training at a sponsored regional course was obtained before performing our first VATS procedure.

RESULTS

VATS allowed more disc to be excised in Group 2 (4.5 +/- 1, 5.7 +/- 1, and 4.4 +/- 1 discs in Group 1, Group 2, and Group 3, respectively) and significantly decreased the anterior operative time (215 +/- 33, 260 +/- 56, and 177 +/- 47 minutes) and time per individual disc excision (50 +/- 13, 47 +/- 12, and 41 +/- 12 minutes), while providing comparable correction of the thoracic deformity (67% +/- 12%, 66% +/- 10%, and 70% +/- 13% correction). There was no increase in estimated intraoperative anterior blood loss (228 +/- 213, 183 +/- 136, and 211 +/- 158 mL), estimated blood loss per disc excised (51 +/- 42, 34 +/- 29 and 48 +/- 37 mL), or complications in the VATS groups. Complications were primarily pulmonary and resolved with medical therapy. Postoperative chest tube drainage (855 +/- 397, 462 +/- 249, and 561 +/- 261 mL) and total perioperative anterior blood loss (1083 +/- 507, 647 +/- 309, and 773 +/- 308 mL) were significantly decreased in the VATS groups, but this was attributed to the use of Amicar.

CONCLUSIONS

VATS is an effective procedure for anterior spinal fusion in idiopathic scoliosis. The learning curve is short, provided appropriate training is obtained.

摘要

研究设计

对接受同期或分期前路与后路脊柱融合及节段性脊柱内固定术的特发性脊柱侧凸患者进行回顾性研究。

目的

评估我们在特发性脊柱侧凸患者中应用电视辅助胸腔镜手术（VATS）时，在手术时间、失血情况及并发症方面的学习曲线。

背景数据总结

VATS是特发性脊柱侧凸治疗中开胸手术的一种微创替代方法。在该技术的最初应用中，已描述了学习曲线增加或陡峭的情况。

方法

我们于1998年开始开展VATS。我们将连续的前25例VATS患者（第2组）和随后连续的28例VATS患者（第3组）与之前连续的16例接受开胸手术（1991 - 1998年）治疗特发性脊柱侧凸的患者（第1组）进行比较。在进行首例VATS手术前，我们在一个赞助的区域课程中接受了培训。

结果

VATS使第2组能够切除更多椎间盘（第1组、第2组和第3组分别为4.5±1、5.7±1和4.4±1个椎间盘），并显著缩短了前路手术时间（分别为215±33、260±56和177±47分钟）以及每个椎间盘切除的时间（分别为50±13、47±12和41±12分钟），同时在胸段畸形矫正方面提供了相当的效果（矫正率分别为67%±12%、66%±10%和70%±13%）。VATS组术中估计前路失血量（分别为228±213、183±136和211±158 mL）、每个切除椎间盘的估计失血量（分别为51±42、34±29和48±37 mL）或并发症均未增加。并发症主要为肺部并发症，通过药物治疗得以解决。VATS组术后胸腔闭式引流量（分别为855±397、462±249和561±261 mL）和围手术期前路总失血量（分别为1083±507、647±309和773±308 mL）显著减少，但这归因于使用了氨基己酸。