Bartlett William, Garrido Enrique, Wallis Colin, Tucker Stewart K, Noordeen Hilali
Department of Spinal Surgery, Great Ormond Street Hospital for Children, London, UK.
Spine (Phila Pa 1976). 2009 Jan 1;34(1):E59-65. doi: 10.1097/BRS.0b013e318191f389.
Case series.
We report the treatment of 2 children with right main bronchus obstruction complicating thoracic lordoscoliosis.
The preoperative investigation and treatment of large airway obstruction caused by lordoscoliosis has not been reported in the literature.
Obstruction of the right main bronchus was confirmed before surgery by ventilation-perfusion scans, bronchogram, and computed tomography scan. Deformity correction was achieved using a submuscular growth rod construct in one child, and posterior spinal fusion in the other. Clinical examination and repeat ventilation-perfusion scans were performed 8 weeks after surgery.
In both children, ventilation to the right "convex" lung was reestablished after surgery. Lung function improved in both patients after surgery.
This is the first report of large airway obstruction associated with thoracic lordoscoliosis in which ventilation was reestablished after spinal deformity correction. Early deformity correction is indicated in such cases because of the risk of irreversible compromise to lung ventilation and perfusion.
病例系列。
我们报告2例患有右主支气管阻塞并发胸椎脊柱侧弯的儿童的治疗情况。
文献中尚未报道脊柱侧弯引起的大气道阻塞的术前检查和治疗。
术前通过通气灌注扫描、支气管造影和计算机断层扫描确认右主支气管阻塞。其中一名儿童采用肌下生长棒结构进行畸形矫正，另一名儿童采用后路脊柱融合术。术后8周进行临床检查和重复通气灌注扫描。
两名儿童术后右“凸”肺均恢复通气。两名患者术后肺功能均有所改善。
这是第一例与胸椎脊柱侧弯相关的大气道阻塞病例报告，其中脊柱畸形矫正后恢复了通气。由于存在肺通气和灌注不可逆损害的风险，此类病例应尽早进行畸形矫正。
