Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
Spine (Phila Pa 1976). 2011 Oct 1;36(21):E1391-4. doi: 10.1097/BRS.0b013e31820cd489.
Retrospective study.
To evaluate the prognostic value of preoperative pulmonary function test (PFT) for postoperative pulmonary complications and to identify the operability associated with severely decreased forced vital capacity (FVC) (<30%) status in flaccid neuromuscular scoliosis.
The preoperative PFT, especially more than 30% FVC, is known as a critical factor for the operability of flaccid neuromuscular scoliosis. But only one study reported that patients with pre-existing respiratory failure on nocturnal noninvasive ventilation can undergo an operation for deformity correction without mortality and severe complications.
A total of 74 patients (45 male and 29 female) presented with flaccid neuromuscular scoliosis. For all patients, preoperative PFTs were evaluated and subdivided into three groups (<30% FVC, 30%-50% FVC, and >50% FVC). Then postoperative pulmonary complications, pneumothorax, pneumonia, atelectasis, prolonged ventilator care in the intensive care unit (more than 72 hours), and postoperative tracheostomy were evaluated.
Among these patients, 59 had muscular dystrophy; 5, spinal muscular atrophy; 2, cerebral palsy; and 8, others. The mean age at surgery was 16.8 years (range, 5-32 years). The mean preoperative Cobb angle was 54.6° (16°-135°). The overall postoperative pulmonary complication rate was 31% (23 complications in 74 patients). The less than 30% FVC group had 6 complications among 18 patients; the 30% to 50% FVC group had 7 complications among 18 patients; and the more than 50% FVC group had 10 complications among 38 patients. There were no deaths during the perioperative period. There is no statistical difference between the three groups (P = 0.6195).
Patients with flaccid neuromuscular scoliosis can undergo an operation for deformity correction regardless of the severely decreased pulmonary function.
回顾性研究。
评估术前肺功能检查（PFT）对术后肺部并发症的预后价值，并确定在弛缓性神经肌肉性脊柱侧凸中，与严重降低的用力肺活量（FVC）（<30%）状态相关的可操作性。
术前 PFT，尤其是 FVC 超过 30%，被认为是弛缓性神经肌肉性脊柱侧凸可操作性的关键因素。但仅有一项研究报告称，存在夜间无创通气呼吸衰竭的患者可以进行畸形矫正手术，且无死亡和严重并发症。
共纳入 74 例（男 45 例，女 29 例）弛缓性神经肌肉性脊柱侧凸患者。对所有患者进行术前 PFT 评估，并分为三组（FVC<30%、30%-50%和>50%）。然后评估术后肺部并发症、气胸、肺炎、肺不张、重症监护病房（ICU）呼吸机辅助时间延长（>72 小时）和术后气管切开术。
这些患者中，59 例为肌营养不良症，5 例为脊髓性肌萎缩症，2 例为脑瘫，8 例为其他疾病。手术时的平均年龄为 16.8 岁（5-32 岁）。术前平均 Cobb 角为 54.6°（16°-135°）。总体术后肺部并发症发生率为 31%（74 例患者中有 23 例并发症）。FVC<30%组 18 例患者中有 6 例并发症；30%-50%组 18 例患者中有 7 例并发症；FVC>50%组 38 例患者中有 10 例并发症。围手术期无死亡。三组间无统计学差异（P=0.6195）。
无论肺功能严重下降如何，弛缓性神经肌肉性脊柱侧凸患者都可以进行畸形矫正手术。
