Nicolai T, Opitz G, Zielke K
Universitäts-Kinderklinik München.
Monatsschr Kinderheilkd. 1989 Sep;137(9):592-6.
Previous investigations have reported conflicting results on the development of lung function and body height after operative correction of scoliosis at young age. Partly the number of patients or the duration of observation were relatively small. 120 patients were followed for at least 10 years (10-14, average 12 years) after surgical correction of scoliosis at the age of 18.2 +/- 6.8 years. Standing height and vital capacity were measured 1, 2, 5 and 10 years after operation. Height was expressed as percentile for age and vital capacity as % expected for actual height. The primary diagnoses were idiopathic scoliosis (n = 84, average Cobb angle 90 degrees), congenital scoliosis (n = 20, 83 degrees), poliomyelitis (n = 10, 128 degrees), neurofibromatosis (n = 6, 101 degrees). We found an initial decrease in lung function after 1 year, which was probably due to post-operative immobilization and increased by the gain in body height achieved by the operation. During the rest of the observation period a significant (p less than 0.05) increase of vital capacity (% of expected for actual height) was observed. The gain was maximal for idiopathic scoliosis (+6%). In congenital scoliosis body height %ile and relative vital capacity appeared fixed at the preoperative level. Interestingly patients with an initial vital capacity below 50% expected (n = 29) or preoperative Cobb angle above 90 degrees showed the best results. They also lacked the initial deterioration of lung function in the first postoperative year and had a significant gain of vital capacity (+14%) over 10 years.(ABSTRACT TRUNCATED AT 250 WORDS)
先前的研究报告了关于幼年脊柱侧弯手术矫正后肺功能和身高发育的相互矛盾的结果。部分原因是患者数量或观察时间相对较少。120例患者在18.2±6.8岁接受脊柱侧弯手术矫正后至少随访了10年(10 - 14年,平均12年)。在术后1年、2年、5年和10年测量站立身高和肺活量。身高以年龄百分位数表示,肺活量以实际身高预期值的百分比表示。主要诊断为特发性脊柱侧弯(n = 84,平均Cobb角90度)、先天性脊柱侧弯(n = 20,83度)、小儿麻痹症(n = 10,128度)、神经纤维瘤病(n = 6,101度)。我们发现术后1年肺功能最初下降,这可能是由于术后制动,且因手术带来的身高增加而加剧。在其余观察期内,观察到肺活量(实际身高预期值的百分比)显著(p < 0.05)增加。特发性脊柱侧弯的增加最大(+6%)。在先天性脊柱侧弯中,身高百分位数和相对肺活量似乎固定在术前水平。有趣的是,初始肺活量低于预期50%(n = 29)或术前Cobb角大于90度的患者显示出最佳结果。他们在术后第一年也没有肺功能的初始恶化,并且在10年中肺活量显著增加(+14%)。(摘要截短于250字)