青少年特发性脊柱侧凸患者脊柱融合术后肺形态的统计学变化——一项基于低剂量双平面X线成像的前瞻性非随机研究
Statistical changes of lung morphology in patients with adolescent idiopathic scoliosis after spinal fusion surgery-a prospective nonrandomized study based on low-dose biplanar X-ray imaging.
作者信息
Deng Min, Chen Qianyun, Deng Qiao, Shi Lin, Cheng Cherry Cheuk Nam, Yeung Kwong Hang, Zhang Rongli, Yu Wai Ping Fiona, Lam Tsz Ping, Cheng Jack Chun Yiu, Chu Winnie Chiu Wing
机构信息
Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
出版信息
Quant Imaging Med Surg. 2022 Jun;12(6):3325-3339. doi: 10.21037/qims-21-1147.
BACKGROUND
Adolescent idiopathic scoliosis (AIS) patients suffer from restrictive impairment of pulmonary function (PF) as a consequence of spinal and ribcage deformity. Statistic modelling of scoliotic geometry has been well-established based on low-dose biplanar X-ray device (EOS) imaging. However, the postoperative lung morphology change derived from EOS has not yet been studied adequately till now.
METHODS
Twenty-five female AIS patients with severe right-sided major thoracic curve (aged 13-31 years; Cobb angle 45°-92°) underwent posterior spinal fusion (PSF) were prospectively recruited for standing EOS imaging at preoperative, postoperative, and 1-year follow-up (1Y-FU) stages. EOS-based lung morphology at frontal and lateral view was measured respectively to assess serial statistical changes in area and height.
RESULTS
At frontal view, left lung area significantly increased postoperatively (104.7 125.1 cm; P<0.001) but without continuous increase at 1Y-FU (125.1 124.5 cm; P=0.084), whereas right lung area showed a slight but insignificant interval increase (median: 143.8, 146.5, 148.4 cm at preoperative, postoperative, 1Y-FU stage, respectively; all P>0.05). At lateral view, the increase in left lung area was slight without statistically difference (median: 175.8, 178.4, 182.5 cm at preoperative, postoperative, 1Y-FU stage, respectively; all P>0.05), while right lung area did not significantly change postoperatively (median: 209.9, 206.7, 212.4 cm at preoperative, postoperative, 1Y-FU stage, respectively; all P>0.05). At both frontal and lateral view, left lung height significantly improved at both postoperative and 1Y-FU stage (all P<0.05), while preoperative right lung height was not significantly different from postoperative and 1Y-FU value (all P>0.05).
CONCLUSIONS
EOS imaging demonstrates that left lung area in severe AIS may improve after PSF surgery. EOS may provide useful information about lung morphology change after PSF in severe AIS.
背景
青少年特发性脊柱侧凸（AIS）患者由于脊柱和胸廓畸形而出现肺功能（PF）的限制性损害。基于低剂量双平面X射线设备（EOS）成像，脊柱侧凸几何形状的统计建模已得到充分确立。然而，迄今为止，源自EOS的术后肺形态变化尚未得到充分研究。
方法
前瞻性招募25例患有严重右侧胸主弯的女性AIS患者（年龄13 - 31岁；Cobb角45° - 92°），她们接受了后路脊柱融合术（PSF），并在术前、术后和1年随访（1Y - FU）阶段进行站立位EOS成像。分别测量正位和侧位基于EOS的肺形态，以评估面积和高度的系列统计变化。
结果
在正位视图中，左肺面积术后显著增加（104.7±125.1 cm²；P<0.001），但在1年随访时没有持续增加（125.1±124.5 cm²；P = 0.084），而右肺面积显示出轻微但无统计学意义的间隔增加（术前、术后、1年随访阶段的中位数分别为：143.8、146.5、148.4 cm²；所有P>0.05）。在侧位视图中，左肺面积的增加轻微，无统计学差异（术前、术后、1年随访阶段的中位数分别为：175.8、178.4、182.5 cm²；所有P>0.05），而右肺面积术后无显著变化（术前、术后、1年随访阶段的中位数分别为：209.9、206.7、212.4 cm²；所有P>0.05）。在正位和侧位视图中，左肺高度在术后和1年随访阶段均显著改善（所有P<0.05），而术前右肺高度与术后和1年随访值无显著差异（所有P>0.05）。
结论
EOS成像显示，严重AIS患者的左肺面积在PSF手术后可能会改善。EOS可能为严重AIS患者PSF术后的肺形态变化提供有用信息。
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