Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands; Department of Orthopaedic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands.
Spine J. 2022 Jul;22(7):1178-1190. doi: 10.1016/j.spinee.2021.12.011. Epub 2021 Dec 25.
One of the controversies in untreated idiopathic scoliosis is the influence of curve size on respiratory function. Whereas scoliosis patients with curves over 90 to 100 degrees are agreed to be at risk for cardiorespiratory failure in later life, the impairment of curves below 90 degrees is generally considered mild. Although various studies showed that pulmonary function is affected in patients with scoliosis, quantification of the relation between curve size and pulmonary function is lacking.
This systematic review with meta-regression analysis aims to characterize the relation between pulmonary function tests and scoliosis severity in children and adolescents with idiopathic scoliosis.
Systematic review with meta-regression analysis.
Pubmed, Embase, Cochrane, and CINAHL were systematically searched until November 3, 2020, for original articles that reported (1) severity of scoliosis quantified in Cobb angle, and (2) pulmonary function tests in children and adolescents with untreated idiopathic scoliosis. Exclusion criteria were other types of scoliosis, non-original data, post-treatment data, and case reports. All study designs were included, and relevant study details and patient characteristics were extracted. The primary outcome was the effect of Cobb angle on pulmonary function as expressed by the slope coefficient of a linear meta-regression analysis.
A total of 126 studies, including 8,723 patients, were retrieved. Meta-regression analysis revealed a statistically significant inverse relation between thoracic Cobb angle and absolute and predicted forced vital capacity in 1 second, forced vital capacity, vital capacity, and total lung capacity. For these outcomes, the slope coefficients showed a decrease of 1% of the predicted pulmonary function per 2.6 to 4.5 degrees of scoliosis. A multivariable meta-regression analysis of potential confounders (age, year of publication, and kyphosis) hardly affected the majority of the outcomes.
This meta-regression analysis of summary data (means) from 126 studies showed an inverse relationship between the thoracic Cobb angle and pulmonary function. In contrast to previous conclusions, the decline in pulmonary function appears to be gradual over the full range of Cobb angles between <20 and >120 degrees. These findings strengthen the relevance of minimizing curve progression in children with idiopathic scoliosis.
在未经治疗的特发性脊柱侧凸中存在一个争议，即曲度大小对呼吸功能的影响。尽管患有超过 90 到 100 度的脊柱侧凸的患者被认为在以后的生活中有发生心肺衰竭的风险，但通常认为低于 90 度的脊柱侧凸的损害是轻微的。尽管各种研究表明脊柱侧凸患者的肺功能受到影响，但缺乏对曲线大小与肺功能之间关系的定量分析。
本系统评价通过荟萃回归分析旨在描述特发性脊柱侧凸儿童和青少年的肺功能测试与脊柱侧凸严重程度之间的关系。
系统评价和荟萃回归分析。
系统检索 Pubmed、Embase、Cochrane 和 CINAHL，直至 2020 年 11 月 3 日，以获取报道（1）使用 Cobb 角定量的脊柱侧凸严重程度，以及（2）未治疗的特发性脊柱侧凸儿童和青少年肺功能测试的原始文章。排除标准为其他类型的脊柱侧凸、非原始数据、治疗后数据和病例报告。纳入所有研究设计，并提取相关研究细节和患者特征。主要结局为 Cobb 角对肺功能的影响，表现为线性荟萃回归分析的斜率系数。
共检索到 126 项研究，包括 8723 例患者。荟萃回归分析显示，在 1 秒时的绝对和预测用力肺活量、用力肺活量、肺活量和总肺活量方面，胸腔 Cobb 角与肺功能呈统计学显著负相关。对于这些结果，斜率系数显示脊柱侧凸每增加 2.6 到 4.5 度，预测肺功能下降 1%。对年龄、发表年份和后凸等潜在混杂因素的多变量荟萃回归分析几乎没有影响大多数结果。
本荟萃回归分析综合了 126 项研究的汇总数据（平均值），显示胸腔 Cobb 角与肺功能呈负相关。与之前的结论相比，肺功能的下降似乎在 Cobb 角 20 度到 120 度之间的整个范围内是逐渐的。这些发现加强了在特发性脊柱侧凸儿童中最小化曲线进展的相关性。
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