Department of Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences, Beijing, China.
Department of Orthopaedic Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Hutong, Beijing, 100730, People's Republic of China.
J Orthop Surg Res. 2021 Jul 31;16(1):475. doi: 10.1186/s13018-021-02607-y.
Previous reports confirmed early spinal fusion may compromise pulmonary function and thoracic development in skeletal immature patients with scoliosis. However, the different effects in patients with various Risser signs remain unknown. This study aimed to compare the influence of early thoracic fusion on pulmonary function and thoracic growth in patients with idiopathic scoliosis (IS) with closed triangular cartilage (TRC) and different Risser signs.
Thirty-six patients with IS and a closed TRC were retrospectively selected and divided into the low Risser (LR, Risser sign ≤2, 22 patients) and high Risser (HR, 2<Risser sign≤4, 14 patients) groups. Patient age, Risser sign, main Cobb angle, thoracic kyphosis, and fusion levels were recorded. Perioperative and minimum of 2-year follow-up pulmonary function and thoracic diameters were compared between both groups.
There were no differences in patients' general characteristics between two groups. The preoperative forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were 2.06±0.43 L and 2.50±0.49 L, respectively, in the LR group, and 2.31±0.49 L (p = 0.067) and 2.74±0.56 L (p = 0.122), respectively, in the HR group. While these values significantly increased postoperatively, to 2.62±0.46 L (p < 0.001) and 3.09±0.69 L (p < 0.001), in the LR group, they remained unchanged in the HR group [2.53±0.56 L (p = 0.093) and 2.70±0.98 L (p = 0.386), respectively]. The FEV1/FVC in both groups was >80% before and after surgery. The T1-T12 and anteroposterior thoracic diameter significantly increased after surgery in both groups, while the maximum inner chest diameter only increased in the LR group at the final follow-up. However, there were no significant differences in respiratory function and thoracic data between both groups.
For patients with IS, early fusion did not deteriorate pulmonary function or thoracic development in TRC-closed patients whose Risser sign was ≤2 compared with those with a Risser sign >2.
先前的报告证实，早期脊柱融合可能会损害骨骼未成熟的脊柱侧凸患者的肺功能和胸廓发育。然而，不同 Risser 征患者的影响尚不清楚。本研究旨在比较早期胸段融合对闭合三角软骨（TRC）和不同 Risser 征的特发性脊柱侧凸（IS）患者肺功能和胸廓生长的影响。
回顾性选择 36 例 IS 伴闭合 TRC 的患者，分为低 Risser（LR，Risser 征≤2，22 例）和高 Risser（HR，2<Risser 征≤4，14 例）组。记录患者年龄、Risser 征、主弯 Cobb 角、胸椎后凸和融合节段。比较两组患者术前及术后至少 2 年的肺功能和胸径。
两组患者一般特征无差异。LR 组术前 1 秒用力呼气容积（FEV1）和用力肺活量（FVC）分别为 2.06±0.43 L 和 2.50±0.49 L，HR 组分别为 2.31±0.49 L（p=0.067）和 2.74±0.56 L（p=0.122）。术后均明显增加，LR 组分别为 2.62±0.46 L（p<0.001）和 3.09±0.69 L（p<0.001），HR 组无变化[分别为 2.53±0.56 L（p=0.093）和 2.70±0.98 L（p=0.386）]。两组术前和术后 FEV1/FVC 均>80%。两组 T1-T12 和前后胸径术后均明显增加，而 LR 组在末次随访时仅最大胸腔内径增加。然而，两组间呼吸功能和胸径数据无显著差异。
对于 IS 患者，与 Risser 征>2 的患者相比，TRC 闭合且 Risser 征≤2 的患者早期融合不会使肺功能或胸廓发育恶化。
