Lim Moe, Wazeka April, Boachie-Adjei Oheneba
Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
Spine (Phila Pa 1976). 2003 Jul 1;28(13):E256-9. doi: 10.1097/01.BRS.0000067284.88200.B4.
Ventilator weaning after staged revision anteroposterior spine fusion in a ventilator-dependent child with congenital scoliosis is reported.
To describe the improvement of pulmonary performance after deformity correction in a patient with severe deformity and severe restrictive lung disease.
The effect of scoliotic deformity correction on postoperative pulmonary function is debatable. Recent prospective studies suggest that corrective surgery, especially that involving violation of the chest cage, adversely affect pulmonary function in patients with adolescent idiopathic scoliosis. For patients with severe deformity and severely compromised preoperative pulmonary function, the effect of deformity correction has not been well studied.
A 15-year-old ventilator-dependent girl with progressive congenital thoracic scoliosis of 130 degrees and a forced vital capacity of 18% underwent staged revision anteroposterior spine fusion. Anterior release, multiple vertebral osteotomies, apical vertebrectomy, and multiple internal thoracoplasties were performed. Five weeks later, when she was medically stable, she underwent posterior reconstruction with multiple vertebral osteotomies, apical vertebrectomy, and translation and cantilever corrective techniques using Isola instrumentation.
The patient's pulmonary function was stable 6 months after surgery, and her forced vital capacity was 19%. Currently, 1 year after surgery, she has been weaned to night-only ventilation. Her walking ability has improved. Her spine is well balanced with a thoracic scoliosis of 40 degrees, and she is neurologically intact.
Surgical correction of a severe thoracic spinal deformity in the setting of severe restrictive lung disease can be performed successfully with stabilization of pulmonary volumes and improvement in pulmonary performance.
报道了一名依赖呼吸机的先天性脊柱侧凸患儿在分期前后路脊柱融合翻修术后的呼吸机撤机情况。
描述严重脊柱畸形和严重限制性肺病患者在畸形矫正后肺功能的改善情况。
脊柱侧凸畸形矫正对术后肺功能的影响存在争议。近期的前瞻性研究表明，矫正手术，尤其是涉及胸廓侵犯的手术，会对青少年特发性脊柱侧凸患者的肺功能产生不利影响。对于严重畸形且术前肺功能严重受损的患者，畸形矫正的效果尚未得到充分研究。
一名15岁依赖呼吸机的女孩，患有130度进行性先天性胸段脊柱侧凸，用力肺活量为18%，接受了分期前后路脊柱融合翻修术。进行了前路松解、多处椎体截骨、顶椎切除术和多处胸廓成形术。五周后，当她病情稳定时，接受了后路重建，采用多处椎体截骨、顶椎切除术以及使用Isola器械的平移和悬臂矫正技术。
术后6个月患者肺功能稳定，用力肺活量为19%。目前，术后1年，她已撤机至仅夜间通气。她的行走能力有所改善。她的脊柱平衡良好，胸段脊柱侧凸为40度，神经功能完好。
在严重限制性肺病的情况下，成功进行严重胸段脊柱畸形的手术矫正可使肺容积稳定并改善肺功能。
