Glotzbecker Michael P, Gold Meryl, Puder Mark, Hresko M Timothy
Department of Orthopaedic Surgery, Instructor, Harvard Medical School, Children's Hospital Boston, 300 Longwood Avenue, Hunnewell 2, Boston, MA 02115 USA.
Department of Surgery, Children's Hospital Boston, Boston, MA 02115 USA.
J Child Orthop. 2013 Oct;7(4):301-7. doi: 10.1007/s11832-013-0519-2. Epub 2013 Aug 10.
There has been an increased focus on the role of rib abnormalities in the development of scoliosis. Rib resection may influence the development of scoliosis. Although scoliosis has been identified in patients after thoracotomy, most of the currently available information is from case reports.
We examined records of 37 patients who underwent a chest wall or rib resection for rib lesions at our institution during the period of 1992 to 2005. Adequate data was available in 21 patients. We gathered data on demographic information, location of resection, and changes in curvature after resection based on radiograph or scout CT films at the latest follow-up appointment.
Fourteen of 21 patients developed scoliosis with a mean Cobb angle of 25.8° (10°-70°). Eleven of these 14 patients had a progressive spinal deformity after chest wall resection with an average change in curvature of 29° (10°-70°). Eight of those 11 developed a convex toward the resection, while 3/11 developed a convex away from the resection. Seven of the eight patients with resections that included a rib superior to the sixth rib developed scoliosis, while four of 13 with resections below the sixth rib developed scoliosis.
Patients who have had a rib or chest wall resection are at risk for developing scoliosis, particularly if the resection is performed above the sixth rib.
肋骨异常在脊柱侧弯发展中的作用已受到更多关注。肋骨切除可能影响脊柱侧弯的发展。尽管开胸术后患者中已发现脊柱侧弯，但目前大多数可用信息来自病例报告。
我们检查了1992年至2005年期间在我院因肋骨病变接受胸壁或肋骨切除的37例患者的记录。21例患者有足够的数据。我们收集了人口统计学信息、切除部位以及最新随访时基于X线片或定位CT片的切除后曲度变化的数据。
21例患者中有14例发生脊柱侧弯，平均Cobb角为25.8°（10° - 70°）。这14例患者中有11例在胸壁切除后出现进行性脊柱畸形，曲度平均变化29°（10° - 70°）。这11例中有8例凸向切除侧，3例凸向非切除侧。切除包括第六肋以上肋骨的8例患者中有7例发生脊柱侧弯，而切除第六肋以下肋骨的13例中有4例发生脊柱侧弯。
接受肋骨或胸壁切除的患者有发生脊柱侧弯的风险，尤其是切除在第六肋以上时。
