先天性脊柱侧弯患儿术前6分钟步行表现

Preoperative 6-Minute Walk Performance in Children With Congenital Scoliosis.

作者信息

Nakashima Hiroaki, Kawakami Noriaki, Matsumoto Hiroko, Redding Gregory J

机构信息

Meijo Hospital Orthopedics and Spine Center, Naka-ku, Nagoya.

Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi.

出版信息

J Pediatr Orthop. 2020 Oct;40(9):e818-e821. doi: 10.1097/BPO.0000000000001641.

DOI:10.1097/BPO.0000000000001641

PMID:32931689

Abstract

BACKGROUND

The 6-minute walk test (6MWT) is used to assess the function of cardiopulmonary and neuromuscular conditions in adults and children. The primary research question was to determine the relationship between 6MWT distance and forced vital capacity (FVC) and the major curve among children with congenital scoliosis with rib anomalies.

METHODS

The authors recorded 6MWT distance in meters, FVC as a percentage of predicted normal value using arm span for height (FVC%), and Cobb angle in 20 children (13 girls; average age, 6.7±1.3 y) with congenital scoliosis before outpatient surgical treatment. The 6MWT uses a standardized protocol and measures distance traveled in 6 minutes on a flat surface. The authors then determined the correlation between these measures using linear regression analysis.

RESULTS

The Cobb angle of the major curvature was 55.4±20.5 degrees. The type of vertebral anomaly was mixed in 17 cases, formation failure in 2 cases, and segmentation failure in 1 case. The range of rib anomalies was 3.4±3.9 levels; 15 and 5 patients, respectively, had unilateral and bilateral rib anomalies. FVC and FVC% were 0.7±0.2 L and 60%±19%, respectively. The ratio of forced expiratory volume at 1 second to FVC (FEV1/FVC), which indicates obstructive lung disease, was normal at 93%±7%. The 6MWT distance was 386.3±59.4 m, which was ≤10% of the predicted distance for normal children. No child was able to walk the normal distance on the basis of published norms. 6MWT distance was significantly correlated with arm span (ρ=0.46, P=0.04) and major curve (ρ=-0.61, P=0.004), but not with FVC% (ρ=0.17, P=0.49).

CONCLUSIONS

The 6MWT distance is a feasible measure of function and is substantially reduced before surgery in children with thoracic congenital scoliosis with rib anomalies. The 6MWT distance was significantly correlated with a major curve but not with FVC%. 6MWT distance is not affected by moderate lung function impairment.

LEVEL OF EVIDENCE

Level IV-retrospective cohort study.

摘要

背景

6分钟步行试验（6MWT）用于评估成人和儿童心肺及神经肌肉状况的功能。主要研究问题是确定6MWT距离与用力肺活量（FVC）之间的关系，以及先天性脊柱侧凸合并肋骨异常患儿的主要曲线。

方法

作者记录了20例先天性脊柱侧凸患儿（13名女孩；平均年龄6.7±1.3岁）在门诊手术治疗前的6MWT距离（以米为单位）、使用身高臂展预测正常价值百分比表示的FVC（FVC%）和Cobb角。6MWT采用标准化方案，测量在平坦表面6分钟内行走的距离。然后作者使用线性回归分析确定这些测量值之间的相关性。

结果

主弯的Cobb角为55.4±20.5度。椎体异常类型为混合型17例，形成障碍2例，分节障碍1例。肋骨异常范围为3.4±3.9个节段；15例和5例患者分别有单侧和双侧肋骨异常。FVC和FVC%分别为0.7±0.2L和60%±19%。提示阻塞性肺疾病的1秒用力呼气容积与FVC之比（FEV1/FVC）正常，为93%±7%。6MWT距离为386.3±59.4m，≤正常儿童预测距离的10%。根据已发表的标准，没有儿童能够行走正常距离。6MWT距离与臂展显著相关（ρ=0.46，P=0.04）和主弯（ρ=-0.61，P=0.004），但与FVC%无关（ρ=0.17，P=0.49）。