Saito Wataru, Mizuno Kosuke, Inoue Gen, Imura Takayuki, Nakazawa Toshiyuki, Miyagi Masayuki, Shirasawa Eiki, Uchida Kentaro, Takaso Masashi
Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan.
Asian Spine J. 2017 Oct;11(5):787-792. doi: 10.4184/asj.2017.11.5.787. Epub 2017 Oct 11.
Retrospective cohort study.
To investigate the effect of spinal correction on respiratory muscle strength in patients with Duchenne muscular dystrophy (DMD).
Several studies have reported that scoliosis correction in patients with DMD does not improve pulmonary function. In these studies, pulmonary function was evaluated using the traditional spirometric values of percent vital capacity (%VC) and percent forced vital capacity (%FVC). However, traditional spirometry may not be suitable for patients with DMD because the results can be influenced by patient fatigue or level of understanding. Therefore, we evaluated respiratory function focusing on respiratory muscle strength using maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP), in addition to %VC and %FVC.
We retrospectively reviewed 16 patients with DMD who underwent spinal correction surgery between 2006 and 2011 at Kitasato University Hospital. All patients were males, and the mean age was 13.5 years. Respiratory muscle strength was evaluated using MIP, MEP, and SNIP. Measurements were obtained preoperatively and at 1 and 6 months postoperatively, and %VC and %FVC were obtained preoperatively and within 6 months postoperatively.
The mean preoperative and postoperative %VC values were 54.0% and 51.7%, whereas the mean %FVC values were 53.9% and 53.2%, respectively. The mean MIP, MEP, and SNIP values obtained preoperatively and at 1 and 6 months postoperatively were as follows: MIP, 40.5, 42.7 and 47.2 cm HO; MEP, 26.0, 28.0, and 29.0 cm HO; and SNIP, 33.4, 33.0, and 33.0 cm HO; respectively. The mean MIP and MEP values significantly improved postoperatively. There were no significant differences in SNIP, %VC, or %FVC preand postoperatively.
By focusing on respiratory muscle strength, our results suggest that scoliosis correction in patients with DMD might have a favorable effect on respiratory function.
回顾性队列研究。
探讨脊柱矫正对杜氏肌营养不良症（DMD）患者呼吸肌力量的影响。
多项研究报告称，DMD患者的脊柱侧弯矫正并不能改善肺功能。在这些研究中，肺功能是使用传统肺活量测定值中的肺活量百分比（%VC）和用力肺活量百分比（%FVC）来评估的。然而，传统肺活量测定法可能不适用于DMD患者，因为结果可能会受到患者疲劳或理解程度的影响。因此，除了%VC和%FVC外，我们还使用最大吸气压（MIP）、最大呼气压（MEP）和嗅鼻吸气压（SNIP）来评估以呼吸肌力量为重点的呼吸功能。
我们回顾性分析了2006年至2011年间在北里大学医院接受脊柱矫正手术的16例DMD患者。所有患者均为男性，平均年龄为13.5岁。使用MIP、MEP和SNIP评估呼吸肌力量。在术前、术后1个月和6个月进行测量，并在术前和术后6个月内获取%VC和%FVC。
术前和术后的平均%VC值分别为54.0%和51.7%，而平均%FVC值分别为53.9%和53.2%。术前、术后1个月和6个月获得的平均MIP、MEP和SNIP值如下：MIP分别为40.5、42.7和47.2 cmH₂O；MEP分别为26.0、28.0和29.0 cmH₂O；SNIP分别为33.4、33.0和33.0 cmH₂O。术后平均MIP和MEP值显著改善。术前和术后SNIP、%VC或%FVC无显著差异。
通过关注呼吸肌力量，我们的结果表明，DMD患者的脊柱侧弯矫正可能对呼吸功能有有利影响。
