Studies On Convex Short Length Costal Angle Rib Resection Thoracoplasty In Adolescent Idiopathic Scoliosis

ObjectiveTo evaluate the correction of rib hump and the complications of convex short length costal angle rib resection thoracoplasty for the treatment of rib hump deformity in adolescents idiopathic scoliosis.Methods65patients with thoracic or lumbthoracic scoliosis in adolescents idiopathic scoliosis(AIS) with prominent rib hump that treated by pedicle screw instrumentation were retrospectively analyzed after a follow-up of2years in the second affiliated hospital of kunming medical university orthopaedic from January2008to June2012. They were divided into three groups according to the surgical method:N-T group (no thoracoplasty with iliac bone graft),a total of30cases, of which10cases male, female in20cases; C-Tgroup(conventional thoracoplasty)a total of17cases, of which the male in5cases, female12cases;CSCA-Tgroup(convex short length costal angle rib resection thoracoplasty), a total of18cases, of which the male in2cases, female16cases.The preoperative general information of the three groups of patients were compared. The whole operation procedure can be divided into two period.The first period:from the start of operation to complete the wake up text;The second period:from complete of the wake up text to the end of the operation.To collected the operation time and blood loss of the whole operation procedure and each period of the three group. To collected the operation complication and the recovery condition of post operation patients.To compare patients’Cobb angle and the hight of rib hump of pre-operation with the post operation of three group. To compare three groups patients’pulmonary function of pre-operation, to each group. To compare patients" pre-operation pulmonary function with post operation, post3month, post6month. post lyear, post2year.Measurement data was compared using t test and one-way analysis of variance (ANOVA) test,, counting data was compared using X2test and Kruskal-Wallis test.ResultsThree groups of patients’general preoperative data were no statistical difference (p>0.05);There were no statistical difference between the three groups in total blood loss,operation time and the second period blood loss, operation time (p>0.05).The hemorrhage speed of the second and the third phase of group A patients was slower than group B significantly (p<0.05); There were no statistical difference between the three groups in patients’post-operation recovery (p>0.05); There were no statistical difference between the three groups in the correction of the Cobb angle after operation (p>0.05). The patients in CSCA-T group and C-T group get more correction in the correct of rib hump after operate than the patients in N-T group (p>0.05), and there were no statistical difference between the CSCA-T group and C-T group (p>0.05); As to the pulmonary function, There were no statistical difference between the three groups (p>0.05), there were no change after operation in N-T group (p>0.05),otherwise,the pulmonary function get worse after operation and witch get more closely to the pre-operation after3months since the operate in CSCA-T group and C-T group (p<0.05)ConclusionThoracoplasty showed significantly better rib hump correction, convex short length costal angle rib resection thoracoplasty without long time pulmonary function hurt, an the complication of the operation did not damage too much,and which were in control. Convex short length costal angle rib resection thoracoplasty did not create else blood loss and operation time compare to the patients who treated by pedicle screw instrumentation and iliac bone graft, no thoracoplasty.