Scheuermann驼背手术患者的术前肺功能

Preoperative Pulmonary Function in Patients With Operative Scheuermann Kyphosis.

作者信息

Abbi Gaurav, Lonner Baron S, Toombs Courtney S, Sponseller Paul D, Samdani Amer F, Betz Randal R, Shah Suken A, Newton Peter O

机构信息

Department of Orthopaedics, New York University Hospital for Joint Diseases, 820 Second Avenue, New York, NY 10017, USA.

出版信息

Spine Deform. 2014 Jan;2(1):70-75. doi: 10.1016/j.jspd.2013.09.004. Epub 2014 Jan 11.

DOI:10.1016/j.jspd.2013.09.004

PMID:27927445

Abstract

STUDY DESIGN

A multicenter, prospective study of consecutively enrolled surgical patients with Scheuermann kyphosis (SK).

OBJECTIVES

To evaluate the impact of SK on preoperative pulmonary function and to determine which radiographic criteria may help predict pulmonary impairment.

SUMMARY OF BACKGROUND DATA

Pulmonary function in SK is not well studied. Previous studies on adolescent idiopathic scoliosis revealed that certain factors, including the magnitude of the thoracic curve and the number of vertebrae involved, significantly affect pulmonary function.

METHODS

A total of 64 patients with SK were evaluated. Absolute and percent predicted forced vital capacity (FVC), forced expiratory volume in 1 second, and total lung capacity were collected preoperatively. Subjects were divided according to kyphosis apex (thoracic or thoracolumbar) and kyphosis magnitude groups, and compared. Correlation analysis was performed to evaluate the impact of gender, age, kyphosis magnitude, and apex on pulmonary function. American Thoracic Society guidelines were used to classify patients according to the severity of pulmonary impairment.

RESULTS

Mean age was 16 years (range 13-24 years), with 42 males. The percent predicted forced vital capacity was 95.8%, percent forced expiratory volume in 1 second was 92.5%, and percent total lung capacity was 106.2%. The percent predicted FVC differed significantly between the 71°-80° and 81°-90° groups (105% vs. 83%, respectively; p = .016) and the 71°-80° and greater than 90° groups (105% vs. 73%, respectively; p = .009). For percent predicted TLC, patients with greater than 90° had significantly lower average values than those in the 71°-80° range (79% vs. 115%, respectively; p = .016). Greatest kyphosis showed a fairly weak (r = -.24; p < .10) but significant correlation with percent predicted FVC. The percentage of patients with moderate to severe impairment (4%) was lowest in the 71°-80° range, which increased with increasing ranges of kyphosis magnitude: 81°-90° (11%) and greater than 90° (50%).

摘要

研究设计

一项对连续纳入的患有休曼氏后凸畸形（SK）的手术患者进行的多中心前瞻性研究。

目的

评估SK对术前肺功能的影响，并确定哪些影像学标准可能有助于预测肺功能损害。

背景数据总结

SK患者的肺功能研究尚不充分。先前关于青少年特发性脊柱侧凸的研究表明，某些因素，包括胸弯的严重程度和受累椎体的数量，会显著影响肺功能。

方法

共评估了64例SK患者。术前收集了绝对和预测的用力肺活量（FVC）、1秒用力呼气量和肺总量。根据后凸畸形顶点（胸段或胸腰段）和后凸畸形严重程度分组对受试者进行划分并比较。进行相关性分析以评估性别、年龄、后凸畸形严重程度和顶点对肺功能的影响。采用美国胸科学会指南根据肺功能损害的严重程度对患者进行分类。

结果

平均年龄为16岁（范围13 - 24岁），男性42例。预测用力肺活量百分比为95.8%，1秒用力呼气量百分比为92.5%，肺总量百分比为106.2%。预测FVC百分比在71° - 80°组和81° - 90°组之间（分别为105%和83%；p = 0.016）以及71° - 80°组和大于90°组之间（分别为105%和73%；p = 0.009）存在显著差异。对于预测TLC百分比，大于90°的患者平均值显著低于71° - 80°范围的患者（分别为79%和115%；p = 0.016）。最大后凸畸形与预测FVC百分比显示出相当弱（r = -0.24；p < 0.10）但显著的相关性。中重度损害患者的百分比（4%）在71° - 80°范围内最低，随着后凸畸形严重程度范围的增加而增加：81° - 90°（11%）和大于90°（50%）。