Leong J C, Lu W W, Luk K D, Karlberg E M
Department of Orthopaedic Surgery, University of Hong Kong, PR China.
Spine (Phila Pa 1976). 1999 Jul 1;24(13):1310-5. doi: 10.1097/00007632-199907010-00007.
The lung function test by a Plethysmograph enabled calculations to be made of the total lung capacity and vital capacity. A Motion Analysis System (Elite, BTS Inc., Milano, Italy) was used to observe and record chest cage and spinal movements and as to correlate lung function with the chest cage and spine kinematics.
To determine the three-dimensional kinematics and the shape and size changes of the chest cage and thoracic spine motion during deep breathing in healthy and scoliotic individuals.
Lateral flexion plus rotation of the involved vertebrae around a vertical axis causing a decrease in lung function is the main disfigurement of scoliosis. Reports show that even after spinal fusion, reduced vital capacity associated with an increased residual volume are detected. Factors such as angle of scoliosis, length of the spinal column involved, and duration of the deformity influence pulmonary function but do not significantly affect its reduction. Mechanical inefficiency during breathing has not been studied.
Three-dimensional kinematics of the chest cage and spine during breathing were studied in 41 scoliotic patients and in 20 healthy individuals. Three-dimensional chest cage motions relative to the spine and thoracic spine motions relative to T12 were calculated. To examine stiffness of the spine, lateral bending angles were calculated. The lung function test, which including spirometry and lung subdivision, also was performed for the scoliotic patients.
Significant differences (P < 0.05) were found in the movements of the upper level of the chest cage in anteroposterior and vertical directions, ranging from 16.7 to 28.6 mm in healthy individuals and from 12.1 to 24.2 mm in scoliotic patients. The thoracic spine displayed two-dimensional movements posteriorly and vertically during breathing, whereas less movement was seen in scoliotic patients. In addition, overall the scoliotic spine showed signs of stiffness in lateral bending.
The range of movement of the chest cage and spine is more limited in the scoliotic cases. This overall stiffness of the chest cage and the spine may contribute to the mechanical inefficiency and impairment of pulmonary function found in scoliotic patients.
通过体积描记法进行肺功能测试，从而能够计算出肺总量和肺活量。使用运动分析系统（Elite，BTS公司，意大利米兰）来观察和记录胸廓与脊柱的运动，并将肺功能与胸廓和脊柱的运动学相关联。
确定健康个体和脊柱侧弯患者在深呼吸时胸廓和胸椎运动的三维运动学以及胸廓的形状和大小变化。
受累椎体围绕垂直轴的侧屈加旋转导致肺功能下降是脊柱侧弯的主要畸形表现。报告显示，即使在脊柱融合术后，仍可检测到肺活量降低且残气量增加。脊柱侧弯角度、受累脊柱长度和畸形持续时间等因素会影响肺功能，但对其降低程度影响不显著。呼吸过程中的机械效率低下尚未得到研究。
对41例脊柱侧弯患者和20例健康个体在呼吸过程中胸廓和脊柱的三维运动学进行了研究。计算了胸廓相对于脊柱的三维运动以及胸椎相对于T12的运动。为检查脊柱的僵硬程度，计算了侧弯角度。还对脊柱侧弯患者进行了包括肺活量测定和肺细分的肺功能测试。
在胸廓上部前后方向和垂直方向的运动中发现了显著差异（P < 0.05），健康个体的运动范围为16.7至28.6毫米，脊柱侧弯患者为12.1至24.2毫米。胸椎在呼吸过程中在后方和垂直方向表现出二维运动，而脊柱侧弯患者的运动较少。此外，总体而言，脊柱侧弯的脊柱在侧弯时表现出僵硬迹象。
脊柱侧弯病例中胸廓和脊柱的运动范围更有限。胸廓和脊柱的这种整体僵硬可能导致脊柱侧弯患者出现机械效率低下和肺功能受损。
