小兒骨科的微創手術

Minimal Invasive Surgery in Pediatric Orthopedics

近年來微創手術在骨科領域已如火如荼地發展，並在世界各國引起廣大的注意。病患接受微創手術後，理論上可受益於較小的傷口，微量的出血，較短的住院日及提早復健。事實上，在肌肉骨骼系統的解剖特徵，是不利於微創手術的發展，況且為提供骨骼系統足夠的支撐力，過去使用的植入物鋼板尺寸體積，都設計得較為龐大。為跟上所有外科系領域追逐微創手術精神的潮流，骨材研發人員近年來無不致力發展輕薄且符合解剖型態的鋼板植入物和工具，以因應微創手術步驟的需求。再者，使用改良過的手術方法，搭配手術顯微鏡、內視鏡、及影像處理技術輔助，均可有效提升手術的精準度，同時僅些微的軟組織破壞。最近，還有電腦導航和機器手臂的快速進展，更是有助於外科醫師，在有限的手術視野得以順利操作，讓整個微創手術發展又往前邁進。雖然科技發展帶來新技術，我們還是要確保整體手術步驟，是在有效和安全的情況下進行，且給病患帶來同樣滿意的臨床結果。本文主要透過回顧相關文獻及作者累積的臨床治療經驗，概述近年來微創手術在小兒骨科領域的相關進展與應用。範圍涵蓋小兒骨科領域常見的脊椎側彎畸形、下肢長短腳、膝內外翻畸形，及足踝關節手術等臨床問題。

The techniques of minimally invasive surgery (MIS) in orthopedics have been worldwide developed in the recent years and drawn a great deal of attention. The patients who undergo MIS procedures theoretically benefit from smaller incision scars, minimized blood loss, shorter hospital stays and quicker rehabilitation. In fact, the anatomic features of musculoskeletal system have less superiority for evolving MIS techniques and many previous orthopaedic implants were substantially bulky in order to provide reliable fixation strength. Since the trend of MIS in all surgical departments has been ascertained, the manufacturers devoted to re-design low-profile and anatomic implants and tools to meet the requests of MIS procedures. Along with the use of modified procedures, operating microscopes, endoscopes, and imaging modalities, operations can be performed with greater precision and less soft tissue trauma. The rapid advances in computer-navigation and robotics as tools to enhance the surgeon's vision in the limited operative filed is another step forward. With these new techniques and technologies, we must ensure that these procedures are performed safely and effectively with predictable clinical outcomes. This article aims to review the literatures and summarize the current applications of minimal invasive surgery in pediatric orthopaedics, including scoliosis, lower limb deformities and ankle-foot surgery.