术后肺功能是否应成为影响青少年特发性脊柱侧凸手术中上位器械椎选择的标准？
Should postoperative pulmonary function be a criterion that affects upper instrumented vertebra selection in adolescent idiopathic scoliosis surgery?
机构信息
*Department of Orthopedic Surgery, Kanazawa University, Kanazawa, Japan †Department of Orthopedic Surgery, Rady Children's Hospital and Health Center, San Diego, CA ‡Department of Orthopedic Surgery, Children's Hospital of Orange County, Orange, CA §Department of Orthopedic Surgery, University of California San Diego, San Diego, CA.
出版信息
Spine (Phila Pa 1976). 2013 Oct 15;38(22):1920-6. doi: 10.1097/BRS.0b013e3182a637a8.
STUDY DESIGN
A multicenter, prospective evaluation of pulmonary function testing (PFT) and radiographical measures in patients surgically treated for adolescent idiopathic scoliosis (AIS).
OBJECTIVE
The objective of this study was to evaluate pulmonary function to determine whether a more proximal upper instrumented vertebra (UIV) negatively impacts pulmonary function in patients surgically treated for AIS.
SUMMARY OF BACKGROUND DATA
There seems to be increasing concern that a more proximal extent of posterior thoracic spinal instrumentation and fusion reduces postoperative pulmonary function. However, there are few reports that analyze the relation between the selection of UIV and pulmonary function in AIS.
METHODS
PFT and radiographical examination of 154 patients with major thoracic AIS (Lenke type 1-4) undergoing posterior thoracic spinal instrumentation and fusion without thoracoplasty were completed prospectively. Patients were divided into groups based on UIV (T1-T3 vs. T4-T5) and Lenke curve type (2 and 4 vs. 1 and 3) and analyzed respectively. Demographic, radiographical measurements, and PFT data from preoperative and 2-year time points were analyzed.
RESULTS
Patients with a structural upper thoracic curve (Lenke 2 and 4) had significantly lower preoperative PFT values than those without a structural upper thoracic curve (Lenke 1 and 3). Lenke 2 and 4 patients were also more likely to be fused proximally (82%, T1-T3) than those in the Lenke 1 and 3 groups (42%, T1-T3, P< 0.05). Preoperatively, those with UIV from T1 to T3 tended to have lower PFT values than those with UIV from T4-T5; however, only percent total lung capacity was statistically different (P< 0.05). Both UIV groups showed significant increases in all absolute values (forced vital capacity, forced expiratory volume in 1s, total lung capacity) at 2-year follow-up (P< 0.05) as expected with growth, and the percent predicted values (% forced vital capacity, % forced expiratory volume in 1s, % total lung capacity) remained stable.
CONCLUSION
Although patients with UIV: T1-T3 showed slightly lower PFT values than UIV: T4-T5, the presence of a double thoracic curve was the primary cause of PFT reduction in these patients. Including the upper thoracic spine in the fusion had no significant effect on pulmonary function 2 years after surgical correction of AIS.
LEVEL OF EVIDENCE
研究设计
一项多中心前瞻性研究，评估了青少年特发性脊柱侧凸（AIS）患者接受手术治疗后的肺功能测试（PFT）和影像学测量。
目的
本研究旨在评估肺功能，以确定在接受 AIS 手术治疗的患者中，更靠近上胸段的上器械椎（UIV）是否会对肺功能产生负面影响。
背景资料概要
人们越来越关注，更广泛的胸椎后路脊柱内固定融合术会降低术后肺功能。然而，很少有报道分析 UIV 的选择与 AIS 患者肺功能之间的关系。
方法
前瞻性地完成了 154 例主要胸椎 AIS（Lenke 1-4 型）患者的 PFT 和影像学检查，这些患者均接受了后路胸椎脊柱内固定融合术，未行胸廓成形术。根据 UIV（T1-T3 与 T4-T5）和 Lenke 曲线类型（2 型和 4 型与 1 型和 3 型）将患者分为两组，并分别进行分析。分析了术前和 2 年时间点的人口统计学、影像学测量和 PFT 数据。
结果
结构性上胸段脊柱侧凸（Lenke 2 型和 4 型）患者的术前 PFT 值明显低于无结构性上胸段脊柱侧凸（Lenke 1 型和 3 型）患者。Lenke 2 型和 4 型患者更有可能被近端融合（82%，T1-T3），而 Lenke 1 型和 3 型患者则较少（42%，T1-T3，P<0.05）。术前，UIV 为 T1-T3 的患者的 PFT 值往往低于 UIV 为 T4-T5 的患者，但只有总肺容量百分比有统计学差异（P<0.05）。两组患者在 2 年随访时，所有绝对值（用力肺活量、1 秒用力呼气量、总肺容量）均有显著增加（P<0.05），这是生长的预期结果，而预计值百分比（%用力肺活量、%1 秒用力呼气量、%总肺容量）保持稳定。
结论
尽管 UIV：T1-T3 组患者的 PFT 值略低于 UIV：T4-T5 组，但双胸段曲线的存在是这些患者 PFT 值降低的主要原因。在 AIS 手术后 2 年，将上胸椎纳入融合范围对肺功能没有显著影响。
证据等级
3 级。
Zotero 插件