内視鏡を用いた脊柱側弯症の前方矯正固定術

A New System for a Thoracoscopic Approach to Anterior Correction and Fixation to Treat Scoliosis : External Correction and Internal Fixation (ECIF) System

　抄録：アウトリガーを応用し，内視鏡下に，脊柱変形前方矯正固定術を行うシステムの研究開発を1994年から開始した（体外矯正・体内固定術：external correction and internal fixation system：ECIF System）．まず豚屍体胸椎の手術を行い，続いて胸腔鏡視下に生体豚の手術を繰り返し，システムの開発改良を行ったうえで，1999年より臨床応用を開始した．本法を用いた場合，初期平均側弯矯正率は80％以上と強力であり，腋窩線上の少数の15～20mmのポートのみで手術が行え，術後疼痛の軽減，術後回復が速いなどの利点がある．特発性側弯症のインストゥルメンテーションを用いた前方矯正固定術を，胸腔鏡視下に高い矯正率で行える．

　In 1994 we started research and development of a new system for thoracoscopic anterior correction and fixation of spinal deformities (the ECIF-system). After completing animal studies, we began clinical application in 1999. The patient is positioned in the lateral decubitus position. Several 15-mm-diameter ports are made in the thoracic wall, and a screw is inserted for each vertebra. The discs are removed and replaced with bone tips from the rib heads. A rod is inserted into the screw heads, and the shaft of each screw is linked to an outrigger outside the body that is used to correct the scoliosis. The small screw inside the screw head is fixed onto the rod. The surgical results in 26 cases of idiopathic scoliosis followed up for more than 6months showed that the average preoperative Cobb angle of 55 degrees had been improved to 10 degress immediatly postoperativly (average correction rate of more than 80％).