青少年特发性脊柱侧凸的肥胖患者是否保留了更多的胸椎后凸和肺功能？

Do Heavier Patients With Adolescent Idiopathic Scoliosis Have More Preserved Thoracic Kyphosis and Pulmonary Function?

作者信息

Tung Robert, Uvodich Mason, Anderson John T, Carpenter Katie, Sherman Ashley, Lozano Rafael

机构信息

University of Kansas School of Medicine, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.

Children's Mercy-Kansas City, 2401 Gillham Rd, Kansas City, MO 64108, USA.

出版信息

Spine Deform. 2018 Nov-Dec;6(6):704-706. doi: 10.1016/j.jspd.2018.05.007.

DOI:10.1016/j.jspd.2018.05.007

PMID:30348347

Abstract

STUDY DESIGN

Retrospective.

OBJECTIVES

We aimed to determine if heavier patients with adolescent idiopathic scoliosis (AIS) had more preserved thoracic kyphosis (TK), and as a result, more preserved pulmonary function.

SUMMARY OF BACKGROUND DATA

Some believe that childhood weight is predictive of adult sagittal plane parameters, with heavier children having greater TK as adults. Generally, thoracic scoliosis is coupled with loss of TK, which is associated with worsening pulmonary function.

METHODS

A total of 142 patients with AIS and a structural main thoracic curve were analyzed. We excluded patients with structural proximal thoracic curves (Lenke 2 and 4). Standing preoperative radiographs, pulmonary function tests, and preoperative body mass indices (BMIs) were reviewed. The main thoracic Cobb angle, T2-T12 TK, percentage predicted forced vital capacity (FVC) and BMI were recorded. Spearman correlation was determined. Linear regression analysis used FVC as the primary outcome and BMI, TK, and Cobb angle as the independent variables. BMI categories were overweight/obese (BMI ≥25) and normal (BMI <25). Wilcoxon rank-sum tests were performed to detect a difference in TK and BMI between the 2 groups. The Cobb angles between the two groups were analyzed by t tests.

RESULTS

Demonstrated correlations included BMI and FVC (0.37, p ≤.01), FVC and TK (0.26, p <.01), BMI and TK (0.23, p = .01), and FVC and Cobb angle (-0.23, p = .01). Linear regression revealed that Cobb angle (p ≤.01), TK (p <.01), and BMI (p <.01) remained statistically significant predictors of FVC. Wilcoxon rank-sum tests revealed a statistically significant difference between TK (p = .03) and FVC (p <.01) in the overweight/obese group and the normal group, with the overweight/obese group having greater values for both TK and FVC. The Cobb angles between the overweight/obese and normal group were not significantly different (p = .72).

CONCLUSIONS

Heavier AIS patients have greater values of TK and percentage predicted FVC.

LEVEL OF EVIDENCE

Level III.

摘要

研究设计

回顾性研究。

目的

我们旨在确定青少年特发性脊柱侧凸（AIS）较重的患者是否保留了更多的胸椎后凸（TK），从而保留了更多的肺功能。

背景数据总结

一些人认为儿童时期的体重可预测成人矢状面参数，较重的儿童成年后胸椎后凸更大。一般来说，胸椎侧弯与胸椎后凸的丧失相关，这与肺功能恶化有关。

方法

共分析了142例患有AIS且存在结构性胸主弯的患者。我们排除了存在结构性近端胸椎弯（Lenke 2型和4型）的患者。回顾了术前站立位X线片、肺功能测试和术前体重指数（BMI）。记录胸主弯Cobb角、T2 - T12胸椎后凸、预测的用力肺活量（FVC）百分比和BMI。确定Spearman相关性。线性回归分析以FVC作为主要结果，BMI（身体质量指数）、TK（胸椎后凸）和Cobb角作为自变量。BMI类别分为超重/肥胖（BMI≥25）和正常（BMI<25）。进行Wilcoxon秩和检验以检测两组之间TK和BMI的差异。两组之间的Cobb角通过t检验进行分析。

结果

显示的相关性包括BMI与FVC（0.37，p≤0.01）、FVC与TK（0.26，p<0.01）、BMI与TK（0.23，p = 0.01）以及FVC与Cobb角（-0.23，p = 0.01）。线性回归显示Cobb角（p≤0.01）、TK（p<0.01）和BMI（p<0.01）仍然是FVC的统计学显著预测因子。Wilcoxon秩和检验显示超重/肥胖组和正常组在TK（p = 0.03）和FVC（p<0.01）方面存在统计学显著差异，超重/肥胖组的TK和FVC值均更高。超重/肥胖组和正常组之间的Cobb角无显著差异（p = 0.72）。