Koller Heiko, Schulte Tobias L, Meier Oliver, Koller Juliane, Bullmann Viola, Hitzl Wolfgang, Mayer Michael, Lange Tobias, Schmücker Jens
Spine Center Bad Wildungen, Werner-Wicker-Klinik, Im Kreuzfeld 4, 34537, Bad Wildungen, Germany.
Department for Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria.
Eur Spine J. 2017 Jun;26(6):1765-1774. doi: 10.1007/s00586-017-4982-1. Epub 2017 Feb 8.
Isolated thoracoplasty (iTP) on the convex side is performed long time after scoliosis surgery has been performed. ITP is thought to cause a further decline in pulmonary function (PF); however, the amount of decline is ill defined. The objectives of this study were to examine the influence of iTP on the postoperative evolution of PF and rib hump reduction in patients that previously undergone scoliosis surgery.
Over an 11-year period, 75 patients underwent iTP. The authors performed a retrospective case series review. Patients with data from PF tests performed preoperatively and at the last follow-up were included. Minimum follow-up was 12 months. The PF value reported was predicted FVC (FVC%). According to the American Thoracic Society, pulmonary impairment was classified as no impairment (FVC: >80-100%), mild (FVC: >65 ≤80%), moderate (FVC: >50 ≤65), and severe (FVC ≤50%). The outcome was studied using validated measures (SRS-24 score, COMI, and the COPD Assessment Test (CAT)). The CAT is stratified into mild impairment (<10 pts), moderate impairment (10-20 pts), severe impairment (>20-30 pts), and disabled (>30 pts).
Twenty-six patients fulfilled the inclusion criteria. The patients' average age was 28 years at surgery with iTP, and 22 were females; the average BMI was 23, and the average follow-up was 76 months. Twenty of the patients had AIS, and six had congenital scoliosis. The time between scoliosis correction and iTP averaged 39 months. The mean number of resected rib segments was 7, and the mean blood loss was 834 ml. FVC% was 66% preoperatively and 57% at follow-up, with a significant change of 9% (p < .02). Fourteen patients had a FVC% change between preoperation and follow-up that was ≥5%; this change was not dependent on the preoperative FVC%. PF showed a slight but non-significant improvement with longer follow-up. At the time of iTP, the thoracic curve averaged 67°, and thoracic kyphosis averaged 46°. Rib hump height was 34 mm before iTP and 15 mm at follow-up (p < .03). At follow-up, the SRS-24 score was 81, the COMI score was 4 points, and the CAT score was 8 points. Eight patients had a CAT >10. Two patients had a major complication. A comparison of patients with pulmonary impairment preoperation vs. follow-up found 4 vs. 1 patients had no PF impairment, 8 vs. 4 patients had mild impairment, 10 vs. 13 patients had moderate impairment, and 4 vs. 8 patients had severe impairment.
Isolated TP was shown an effective technique for rib hump resection. Six years after iTP, the FVC% declined by an average of 9%. Several patients had long-lasting effects in terms of %FVC decline. iTP should be reserved for patients with significant rib hump deformity.
在脊柱侧弯手术完成很长时间后，对凸侧进行孤立性胸廓成形术（iTP）。iTP被认为会导致肺功能（PF）进一步下降；然而，下降的程度尚不明确。本研究的目的是探讨iTP对先前接受过脊柱侧弯手术患者术后PF演变及肋骨隆凸减少的影响。
在11年期间，75例患者接受了iTP。作者进行了一项回顾性病例系列研究。纳入术前及最后一次随访时进行过PF测试数据的患者。最短随访时间为12个月。报告的PF值为预测用力肺活量（FVC%）。根据美国胸科学会的标准，肺功能损害分为无损害（FVC：>80 - 100%）、轻度（FVC：>65%≤80%）、中度（FVC：>50%≤65%）和重度（FVC≤50%）。使用经过验证的测量方法（SRS - 24评分、COMI和慢性阻塞性肺疾病评估测试（CAT））研究结果。CAT分为轻度损害（<10分）、中度损害（10 - 20分）、重度损害（>20 - 30分）和残疾（>30分）。
26例患者符合纳入标准。接受iTP手术时患者的平均年龄为28岁，女性22例；平均体重指数为23，平均随访时间为76个月。其中20例患者为特发性脊柱侧弯（AIS），6例为先天性脊柱侧弯。脊柱侧弯矫正与iTP之间的平均时间为39个月。切除肋骨节段的平均数量为7个，平均失血量为834毫升。术前FVC%为66%，随访时为57%，有9%的显著变化（p < 0.02）。14例患者术前与随访之间的FVC%变化≥5%；这种变化不依赖于术前FVC%。随着随访时间延长，PF有轻微但不显著的改善。在进行iTP时，胸弯平均为67°，胸椎后凸平均为46°。肋骨隆凸高度在iTP前为34毫米，随访时为15毫米（p < 0.03）。随访时，SRS - 24评分为81分，COMI评分为4分，CAT评分为8分。8例患者的CAT>10分。2例患者出现严重并发症。术前与随访时肺功能损害患者的比较发现，无PF损害的患者分别为4例和1例，轻度损害的患者分别为8例和4例，中度损害的患者分别为10例和13例，重度损害的患者分别为4例和8例。
孤立性胸廓成形术是一种有效的肋骨隆凸切除术技术。iTP术后6年，FVC%平均下降9%。一些患者在FVC%下降方面有长期影响。iTP应仅用于有明显肋骨隆凸畸形的患者。
