Greggi Tiziana, Bakaloudis Georgios, Fusaro Isabella, Di Silvestre Mario, Lolli Francesco, Martikos Konstantinos, Vommaro Francesco, Barbanti-Brodano Giovanni, Cioni Alfredo, Giacomini Stefano
Spine Deformity Department, Istituti Ortopedici Rizzoli, Bologna, Italy.
J Spinal Disord Tech. 2010 Dec;23(8):e63-9. doi: 10.1097/BSD.0b013e3181d268b9.
Retrospective case series review.
To compare two similar groups of adolescents surgically treated for their spinal deformity either by posterior segmental fusion alone (PSF) or by posterior spinal fusion and thoracoplasty (PSF+T); attention was focused on the long-term effects of thoracoplasty on pulmonary function in the surgical treatment of adolescent idiopathic scoliosis.
Posterior spinal arthrodesis with thoracoplasty and an open anterior approach, with respect to a posterior only fusion have been found to have a deleterious effect on pulmonary function for as long as five years postoperatively after surgical treatment of adolescent idiopathic scoliosis.
A group of 40 consecutive adolescent patients, surgically treated between 1998 and 2001 by posterior spinal fusion and thoracoplasty, was compared with a similar cohort of 40 adolescents treated in the same period by posterior segmental fusion alone. Pedicle screw instrumentation alone and a minimum five-year follow-up were requested as inclusion criteria. Both a radiographic analysis and a chart review was performed, evaluating the pulmonary function tests (PFTs), the SRS-30 score questionnaire and the Lenke classification system. A radiographic Rib Hump (RH) assessment was also performed.
The entire series was reviewed at an average clinical follow-up of 8.3 years. There were no statistically significant differences between the two groups in terms of gender, age (PSF+T: 16.3 y vs. PSF: 15.2 y), Lenke curve type classification and preoperative Cobb's main thoracic (MT) curve magnitude (PSF+T: 66° vs. PSF: 63°), whereas both final MT percent correction (PSF+T: 53.03% vs. PSF: 51.35%; P<0.03), RH absolute correction (PSF+T: -2.1 cm vs. PSF: -1.05; P<0.01) and RH overall percent correction (PSF+T: 55.4% vs. PSF: 35.4%; P<0.0001) were greater in the thoracoplasty group. No statistical differences were observed between the two groups in PFTs both pre-operatively and at last follow-up. Nevertheless, comparing preoperative to final PFT'S within each group, only in the PSF group both forced vital capacity and forced expiratory volume in one second showed a statistically significant improvement at final evaluation. At last follow-up visit, the SRS-30 scores did not show any statistical difference between the two groups (total score PSF+T: 4.1 vs. PSF: 4.3).
Our findings suggest that thoracoplasty did not adversely affect long-term PFTs in AIS patients treated by posterior spinal fusion alone using pedicle screws instrumentation, as already highlighted by previous reports. A trend towards better coronal plane correction and rib hump improvement was seen, although not clearly reported in a self-assessment disease-specific questionnaire.
回顾性病例系列研究。
比较两组接受脊柱畸形手术治疗的青少年，一组仅采用后路节段性融合术（PSF），另一组采用后路脊柱融合术加胸廓成形术（PSF+T）；重点关注胸廓成形术对青少年特发性脊柱侧凸手术治疗中肺功能的长期影响。
在青少年特发性脊柱侧凸手术治疗后，与仅行后路融合术相比，后路脊柱融合术加胸廓成形术以及开放前路手术，术后长达五年对肺功能都有不良影响。
选取1998年至2001年间接受后路脊柱融合术加胸廓成形术的40例连续青少年患者，与同期仅接受后路节段性融合术的40例类似青少年患者进行比较。纳入标准要求仅使用椎弓根螺钉内固定且至少随访五年。进行了影像学分析和病历审查，评估肺功能测试（PFT）、SRS-30评分问卷和Lenke分类系统。还进行了影像学肋骨隆凸（RH）评估。
整个系列的平均临床随访时间为8.3年。两组在性别、年龄（PSF+T组：16.3岁 vs. PSF组：15.2岁）、Lenke曲线类型分类和术前Cobb主胸弯（MT）曲线大小（PSF+T组：66° vs. PSF组：63°）方面无统计学显著差异，而胸廓成形术组的最终MT矫正百分比（PSF+T组：53.03% vs. PSF组：51.35%；P<0.03）、RH绝对矫正（PSF+T组：-2.1 cm vs. PSF组：-1.05；P<0.01）和RH总体矫正百分比（PSF+T组：55.4% vs. PSF组：35.4%；P<0.0001）均更高。两组术前和末次随访时的PFT均无统计学差异。然而，比较每组术前与最终的PFT，仅PSF组的用力肺活量和一秒用力呼气量在最终评估时有统计学显著改善。在末次随访时，两组的SRS-30评分无统计学差异（总分PSF+T组：4.1 vs. PSF组：4.3）。
我们的研究结果表明，如先前报告所强调的，胸廓成形术对仅使用椎弓根螺钉内固定行后路脊柱融合术治疗的AIS患者的长期PFT没有不利影响。虽然在特定疾病自我评估问卷中未明确报告，但观察到有冠状面矫正更好和肋骨隆凸改善的趋势。
