Zhu Feng, Chen Wen-jun, Wang Wei-jun, Wang Bing, Zhu Ze-zhang, Zhu Bin, Qiu Yong
Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road No. 321, Nanjing, China.
J Spinal Disord Tech. 2011 Aug;24(6):390-6. doi: 10.1097/BSD.0b013e3182019f1a.
To compare the preoperative and postoperative relative position of the thoracic aorta to the vertebrae in patients with idiopathic scoliosis (IS) after anterior corrective surgery without parietal pleura closure.
To investigate the impact of unrepaired parietal pleura on thoracic aorta migration after anterior correction of right thoracic IS.
Vascular injuries caused by vertebral screws have been reported in several studies. Recent studies showed an anteromedial shift of thoracic aorta after anterior curve correction with closure of the parietal pleura in thoracic IS. Migration of the aorta in patients with nonclosed parietal pleura has not been studied before, although it has been speculated in benefiting the transposition of the aorta and thus reduces the risk of vascular injury.
Fifteen IS patients with predominant right thoracic scoliosis who underwent anterior instrumentation without parietal pleura closure were recruited for the study. There were 10 female and 5 male patients with an average age of 15.9 years. The following parameters were measured on preoperative and postoperative computed tomographic scans: angle α: aorta-vertebral angle; distance a: distance between the aorta and the left rib head; distance b: distance from aorta to vertebral body cortex.
From computed tomographic measurements, the angle α from T5 to T12 ranged from 28.9 to 68.3 degrees before surgery and 18.8 to 63.2 degrees after surgery. The distance a ranged from 5.6 mm to 28.1 mm before surgery and 2.3 mm to 24.3 mm after surgery. The distance b ranged from 1.7 mm to 4.3 mm before surgery and 2.3 mm to 8.0 mm after surgery. These changes in all the parameters reached statistically significant difference at all the levels except in upper and lower end vertebrae (P<0.05).
The thoracic aorta in patients with predominant right thoracic IS migrated posterolaterally relative to the vertebral body after anterior surgery without parietal pleura closure.
比较特发性脊柱侧凸（IS）患者在不闭合脏胸膜的前路矫正手术后胸主动脉与椎体的术前和术后相对位置。
探讨未修复的脏胸膜对右胸IS前路矫正术后胸主动脉移位的影响。
多项研究报道了椎弓根螺钉引起的血管损伤。最近的研究表明，在胸段IS患者中，前路矫正并闭合脏胸膜后胸主动脉会向内侧移位。尽管有人推测未闭合脏胸膜的患者主动脉移位有利于主动脉换位，从而降低血管损伤风险，但此前尚未对这类患者的主动脉移位情况进行研究。
招募15例主要为右胸脊柱侧凸且接受了不闭合脏胸膜的前路内固定手术的IS患者进行研究。其中女性10例，男性5例，平均年龄15.9岁。在术前和术后的计算机断层扫描上测量以下参数：角度α：主动脉-椎体角；距离a：主动脉与左肋头之间的距离；距离b：主动脉到椎体皮质的距离。
根据计算机断层扫描测量结果，术前T5至T12的角度α范围为28.9至68.3度，术后为18.8至63.2度。距离a术前范围为5.6毫米至28.1毫米，术后为2.3毫米至24.3毫米。距离b术前范围为1.7毫米至4.3毫米，术后为2.3毫米至8.0毫米。除上下终椎外，所有参数在所有节段的这些变化均达到统计学显著差异（P<0.05）。
主要为右胸IS的患者在不闭合脏胸膜的前路手术后，胸主动脉相对于椎体向后外侧移位。
