Graham E J, Lenke L G, Lowe T G, Betz R R, Bridwell K H, Kong Y, Blanke K
Washington University, Department of Orthopaedic Surgery, St. Louis, MO, USA.
Spine (Phila Pa 1976). 2000 Sep 15;25(18):2319-25. doi: 10.1097/00007632-200009150-00009.
Prospective study.
To prospectively evaluate sequential pulmonary function tests (PFTs) at a minimum 2-year follow-up after an open anterior spinal fusion (ASF) with instrumentation for thoracic AIS.
Anterior spinal fusion with instrumentation is currently undergoing evaluation as an alternative to posterior spinal fusion (PSF) for thoracic adolescent idiopathic scoliosis (AIS). However, the effect of an open thoracotomy on pulmonary function in these patients is unknown.
Fifty-one patients with thoracic AIS with an average age of 15+0 (range 11+2 to 20+5) had PFTs consisting of volume (FVC), flow (FEV-1), and total lung capacity (TLC). Parameters were obtained preoperatively, and at 3 months, 1 year, and a minimum 2-year follow-up. All patients had a single or double open thoracotomy with the diaphragm kept intact. Fusion levels ranged from T4 (most proximal) to L1 (most distal). The average preoperative thoracic coronal Cobb measurement was 53 degrees (range 38 degrees to 80 degrees ), and the average postoperative coronal measurement was 24 degrees (range 7 degrees to 49 degrees ). The average preoperative thoracic sagittal kyphosis (T5-T12) averaged 22 degrees (range 10 degrees to 58 degrees ), and the average postoperative sagittal kyphosis measured 29 degrees (range 7 degrees to 67 degrees ).
There was a significant decline (P< or =0.05) in PFT absolute values (L) of 19%-FVC, 15%-FEV-1, and 11%-TLC at 3 months postoperatively with subsequent improvement and no statistical difference between preoperative and 2-year postoperative values. When evaluating percent predicted values, there was a statistical decline (P< or =0.05) at 3 months postoperatively averaging 19% FVC, 14% FEV-1, and 12% TLC. These values returned to within 94% to 96% of baseline by the 2-year follow-up visit, but were still statistically less than the preoperative values (P</=0.05).
Pulmonary function following thoracotomy with ASF with instrumentation demonstrated a significant decline of 3-month postoperative PFT values, but returned to preoperative baseline absolute values (L) by the 2-year follow-up visit. The percent predicted values returned to within 95% of baseline 2 years postoperatively. Scoliosis surgeons should be aware of these findings when deciding upon the approach (anterior versus posterior) utilized for thoracic AIS.
前瞻性研究。
对采用器械辅助前路脊柱融合术（ASF）治疗胸段青少年特发性脊柱侧弯（AIS）的患者进行至少2年的随访，前瞻性评估其连续肺功能测试（PFT）结果。
目前正在评估器械辅助前路脊柱融合术作为胸段青少年特发性脊柱侧弯后路脊柱融合术（PSF）替代方案的效果。然而，开胸手术对这些患者肺功能的影响尚不清楚。
51例胸段AIS患者，平均年龄15 + 0岁（范围11 + 2至20 + 5岁），接受了包括肺活量（FVC）、气流（FEV-1）和肺总量（TLC）的肺功能测试。在术前、术后3个月、1年以及至少2年随访时获取各项参数。所有患者均接受了单切口或双切口开胸手术，同时保持膈肌完整。融合节段范围从T4（最上端）至L1（最下端）。术前胸段冠状面Cobb角平均为53度（范围38度至80度），术后冠状面平均测量值为24度（范围7度至49度）。术前胸段矢状面后凸（T5 - T12）平均为22度（范围10度至58度），术后矢状面后凸平均测量值为29度（范围7度至67度）。
术后3个月时，PFT绝对值（L）出现显著下降（P≤0.05），FVC下降19%，FEV-1下降15%，TLC下降11%，随后有所改善，术后2年与术前值之间无统计学差异。在评估预测值百分比时，术后3个月出现统计学下降（P≤0.05），FVC平均下降19%，FEV-1下降14%，TLC下降12%。到2年随访时，这些值恢复到基线的94%至96%，但仍显著低于术前值（P≤0.05）。
采用器械辅助前路脊柱融合术的开胸手术后肺功能显示，术后3个月时PFT值显著下降，但到2年随访时恢复到术前基线绝对值（L）。预测值百分比在术后2年恢复到基线的95%以内。脊柱侧弯外科医生在决定治疗胸段AIS所采用的手术入路（前路与后路）时应知晓这些结果。
