Akazawa Tsutomu, Kotani Toshiaki, Sakuma Tsuyoshi, Nakayama Keita, Iijima Yasushi, Torii Yoshiaki, Iinuma Masahiro, Kuroya Shingo, Asano Kota, Ueno Jun, Yoshida Atsuhiro, Murakami Kenichi, Minami Shohei, Orita Sumihisa, Inage Kazuhide, Shiga Yasuhiro, Nakamura Junichi, Inoue Gen, Miyagi Masayuki, Saito Wataru, Eguchi Yawara, Fujimoto Kazuki, Takahashi Hiroshi, Ohtori Seiji, Niki Hisateru
Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan.
Spine Surg Relat Res. 2020 Aug 31;5(1):22-27. doi: 10.22603/ssrr.2020-0077. eCollection 2021.
The purpose of the present study was to determine, in a mid-term follow-up 5 years or more after surgery, the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and expiratory flow in patients with adolescent idiopathic scoliosis (AIS) who underwent posterior spinal fusion (PSF) with or without thoracoplasty.
The subjects were 134 patients with AIS who underwent PSF between 2004 and 2013. Forty-five patients agreed to participate in the study. We divided the patients into two groups as follows: 24 patients who underwent PSF with thoracoplasty from 2004 to 2010 in the TP group and 21 patients who underwent PSF without thoracoplasty from 2011 to 2013 in the non-TP group. We evaluated whole spine X-ray imaging and pulmonary function tests (PFTs) in these patients. PFTs measured FVC, FEV1, peak expiratory flow (PEF), maximum expiratory flow at 50% FVC (V50), maximum expiratory flow at 25% FVC (V25), and the ratio of V50 to V25 (V50/V25).
The main thoracic curves were 53.6 ± 10.1° before surgery, 19.8 ± 7.6° 1 week after surgery, 22.3 ± 8.3° 2 years after surgery, and 23.3 ± 7.6° at the most recent observation. Compared with preoperative values, FVC, FEV1, and % FEV1 were improved significantly at the most recent observation. No significant difference was observed between % FVC before surgery and at the most recent observation. Compared with preoperative values, PEF, V50, and V25 were improved significantly at the most recent observation. V50/V25 did not change significantly. The changes in PFT values in the TP group and the non-TP group were compared. No significant differences were observed in FVC, % FVC, FEV1, % FEV1, PEF, V50, or V25.
Regardless of whether thoracoplasty was performed or not, FVC, FEV1, and expiratory flow were improved 5 years or later after PSF.
本研究的目的是在手术5年或更长时间的中期随访中，确定接受后路脊柱融合术（PSF）且有或没有胸廓成形术的青少年特发性脊柱侧凸（AIS）患者的用力肺活量（FVC）、第1秒用力呼气容积（FEV1）和呼气流量。
研究对象为2004年至2013年间接受PSF的134例AIS患者。45例患者同意参与研究。我们将患者分为两组如下：2004年至2010年间接受带胸廓成形术的PSF的24例患者为胸廓成形术组（TP组），2011年至2013年间接受不带胸廓成形术的PSF的21例患者为非胸廓成形术组（非TP组）。我们对这些患者进行了全脊柱X线成像和肺功能测试（PFTs）。PFTs测量了FVC、FEV1、呼气峰值流量（PEF）、50%FVC时的最大呼气流量（V50）、25%FVC时的最大呼气流量（V25）以及V50与V25的比值（V50/V25）。
主胸弯术前为53.6±10.1°，术后1周为19.8±7.6°，术后2年为22.3±8.3°，最近一次观察时为23.3±7.6°。与术前值相比，最近一次观察时FVC、FEV1和FEV1%有显著改善。术前FVC%与最近一次观察时相比无显著差异。与术前值相比，最近一次观察时PEF、V50和V25有显著改善。V50/V25无显著变化。比较了TP组和非TP组PFT值的变化。在FVC、FVC%、FEV1、FEV1%、PEF、V50或V25方面未观察到显著差异。
无论是否进行胸廓成形术，PSF术后5年或更晚时FVC、FEV1和呼气流量均得到改善。
