Newton Peter O, Perry Andrew, Bastrom Tracey P, Lenke Lawrence G, Betz Randal R, Clements David, D'Andrea Linda
Department of Orthopedics, Rady Children's Hospital-San Diego, San Diego, CA, USA.
Spine (Phila Pa 1976). 2007 Aug 1;32(17):1875-82. doi: 10.1097/BRS.0b013e31811eab09.
A multicenter study of prospectively collected pulmonary function testing and radiographic measures in patients surgically treated for adolescent idiopathic scoliosis (AIS).
The objectives of this study were 1) to identify the factors that determine pulmonary function more than 2 years after surgery for AIS; and 2) to determine what factors, if any, can predict an increase or decrease in the percent predicted 2-year pulmonary function.
Thoracic spinal deformity can lead to significant pulmonary impairment. Studies have shown that patients with AIS experienced a significantly greater improvement in pulmonary function at 2 years after surgery when treated with a posterior approach compared to an anterior approach.
Pulmonary function testing (PFT) and radiographic examination of 254 patients with AIS were completed prospectively. Demographic data, associations between radiographic measurements of spinal deformity, and the results of spirometry underwent correlation analysis and subsequent step-wise multiple regression analysis.
The variables found to be significant predictors of 2-year pulmonary function (FVC, FEV1, TLC) include: preop PFT (R = 0.20-0.39), having an open thoracotomy (as opposed to thoracoscopic or posterior) (R = 0.07-0.09), surgical time (R = 0.03-0.07), and thoracoplasty (R = 0.02-0.04). These models explain 40 to 51% of the variance in 2-year PFT. For patients undergoing open thoracotomy with a thoracoplasty, approximately 54% had a 15% decrease, or more, in percent predicted PFT. This compared with 11% and 15%, respectively of patients who either had posterior or thoracoscopic procedures with no thoracoplasty that had a 15% decrease or more in percent predicted PFT.
Aside from preoperative PFT values, open anterior approaches predict the largest percent of variance in 2-year PFT. Additionally, a clinically significant reduction in the predicted 2-year pulmonary function is more likely when performing a thoracoplasty. The magnitude of the effects for both these variables, however, is modest. This may facilitate the decision-making process as regards to operative intervention.
一项多中心研究，对接受手术治疗的青少年特发性脊柱侧凸（AIS）患者进行前瞻性收集的肺功能测试和影像学测量。
本研究的目的是：1）确定AIS手术后2年以上决定肺功能的因素；2）确定哪些因素（如果有的话）可以预测2年肺功能预测值的增加或减少。
胸椎畸形可导致严重的肺功能损害。研究表明，与前路手术相比，采用后路手术治疗的AIS患者在术后2年时肺功能有明显更大的改善。
前瞻性地完成了254例AIS患者的肺功能测试（PFT）和影像学检查。对人口统计学数据、脊柱畸形的影像学测量之间的关联以及肺活量测定结果进行相关分析，随后进行逐步多元回归分析。
被发现是2年肺功能（FVC、FEV1、TLC）的重要预测因素的变量包括：术前PFT（R = 0.20 - 0.39）、进行开胸手术（与胸腔镜或后路手术相对）（R = 0.07 - 0.09）、手术时间（R = 0.03 - 0.07）和胸廓成形术（R = 0.02 - 0.04）。这些模型解释了2年PFT中40%至51%的方差。对于接受开胸手术并进行胸廓成形术的患者，约54%的患者肺功能预测值下降15%或更多。相比之下，接受后路或胸腔镜手术且未进行胸廓成形术的患者中，分别有11%和15%的患者肺功能预测值下降15%或更多。
除了术前PFT值外，前路开放手术预测2年PFT中方差的比例最大。此外，进行胸廓成形术时，预测的2年肺功能临床上显著降低的可能性更大。然而，这两个变量的影响程度都较小。这可能有助于手术干预方面的决策过程。
