흉곽 내시경을 사용한 척추 기형 수술시 학습 곡선

Abstract

Study design : Twenty-six consecutive cases were prospectively studied by chart review and radiography. Objectives : The aim of this study was to find the learning curve of spinal thoracoscopy in spinal deformity surgery. Sumriary of Literature Review : Although the efficacy and learning curve of thoracoscopic deformity spinal surgery are well docur tented in many countries, there is no report in Korea. Meth xds : Twenty-six consecutive patients who were underwent VATS were studied. Idiopathic scoliosis was diagnosed in 23 patients (King type II in 15, type III in 5, type IV in 3), neuromuscular scoliosis in 2 and kyphotic deformity in one. In 14 cases of idi )pathic scoliosis VATS for anterior release, bonegraft and instrumentation were performed. In the remaining 12 cases of antes or release, bone graft by VATS was done without instrumentation. Results : The average number of discs excised was 520.97. The average time of surgery for the 14 cases was 7.31.3 hours, which represented 1.37025 hours per disc. Excluding the time of instrumentation in the 26 cases, the average time for anterior release and bone grafting was 3.870.87 hours, which represented 0.760.18 hours per disc. The average operation time dimit7ished as the series continued. Average blood loss was 748.9254 mL, which represented 152.665.6 mL per disc. The Cobb´ s angle was corrected by 62% on average. Complications were found in 11 cases: screw cap breakage in 3, atelectasis in 4, and it ttercostal nerve injury in 4. There was no serious complication. Concl isions : VAST for spinal deformity is a safe and effective alternative to thoracotomy, however, the learning curve for this proce,lure is quite difficult.