Department of Orthopedics, Scoliosis Research Institute, Korea University Guro Hospital, Seoul, Korea.
Spine (Phila Pa 1976). 2013 Jan 1;38(1):37-43. doi: 10.1097/BRS.0b013e3182784cdc.
Prospective case series study.
To study the effect of percutaneous thoracoplasty-only procedure on curve pattern in mature adolescent idiopathic scoliosis (AIS).
The rib hump prominence on the convex side is the major cosmetic concern among patients with AIS. Thoracoplasty combined with spinal fusion is a commonly used procedure in scoliosis. However, there are no studies regarding the effect of isolated thoracoplasty procedure on curve pattern in skeletally matured patients with AIS.
The study involved 7 skeletally matured female patients with AIS. The convex rib hump deformity was measured preoperatively using hump height and hump angle. We performed thoracoplasty without spinal fusion in patients with the Cobb angle less than 40° but with prominent hump deformity. Thoracoplasty was performed percutaneously using 1 or 2 transverse incisions along the rib hump, and apex portions of the deformed ribs were resected. The Cobb angle was measured before surgery, immediately after surgery, and at final follow-up visit. In all cases, clinical satisfaction was assessed using the Scoliosis Research Society Instrument (SRS-22 questionnaires) and trunk appearance perception scale before surgery and at final follow-up visit.
The mean patient age was 20.24 years and an average of 4 ribs were resected. The mean preoperative hump height and hump angle of 38.14 mm and 14.14° improved to 11.70 mm and 11.42° respectively, after surgery (P = 0.018 and 0.042). Preoperative and the final follow-up mean Cobb angles were 35.43° and 45.00°, respectively (P = 0.028). On average, the mean thoracic curve progressed by 9.57°. Preoperative Scoliosis Research Society Instrument SRS-22 questionnaires and trunk appearance perception scale scores of 4.09 and 2.57 respectively improved to and 4.26 and 3.66 after surgery (P = 0.126 and 0.014).
Percutaneous thoracoplasty-only procedure gives significant rib humps correction and satisfactory clinical outcome. However, progression of the curve was observed after surgery. This suggests that the convex ribs function as a buttress for curve progression.
前瞻性病例系列研究。
研究单纯经皮开胸术对成熟青少年特发性脊柱侧凸（AIS）曲线模式的影响。
脊柱侧凸患者凸侧的肋骨隆凸是主要的美容关注点。胸廓成形术联合脊柱融合术是脊柱侧凸的常用方法。然而，目前尚无关于单纯胸廓成形术对成熟骨骼 AIS 患者的曲线模式的影响的研究。
研究纳入 7 例成熟女性 AIS 患者。术前使用隆起高度和隆起角度测量凸侧肋骨隆起畸形。对于 Cobb 角小于 40°但存在明显隆起畸形的患者，我们行单纯胸廓成形术而不进行脊柱融合。经皮采用 1 或 2 个横切口沿肋骨隆起进行胸廓成形术，切除变形肋骨的顶点部分。在手术前、手术后即刻和最终随访时测量 Cobb 角。所有患者均使用脊柱侧凸研究协会量表（SRS-22 问卷）和术前及最终随访时的躯干外观感知量表评估临床满意度。
患者平均年龄为 20.24 岁，平均切除 4 根肋骨。术前 38.14mm 的平均隆起高度和 14.14°的隆起角度改善为术后的 11.70mm 和 11.42°（P = 0.018 和 0.042）。术前和最终随访时的平均 Cobb 角分别为 35.43°和 45.00°（P = 0.028）。平均而言，胸弯进展 9.57°。术前脊柱侧凸研究协会量表 SRS-22 问卷和躯干外观感知量表评分分别为 4.09 和 2.57，术后分别改善至 4.26 和 3.66（P = 0.126 和 0.014）。
单纯经皮开胸术可显著矫正肋骨隆凸畸形，并获得满意的临床效果。然而，术后发现曲线进展。这表明凸侧肋骨作为曲线进展的支撑。
