Department of Orthopaedics, PGIMER, Chandigarh, India.
Queens Medical Center, Nottingham, UK.
Eur Spine J. 2022 Nov;31(11):2972-2986. doi: 10.1007/s00586-022-07375-9. Epub 2022 Sep 7.
Thoracoplasty is a procedure which involves rib resection from the costovertebral junction to the apex of the rib hump deformity to address the cosmetic concerns of patients of scoliosis. There is conflicting literature on its effect on pulmonary function. The present meta-analysis was conducted to review and analyze the available literature and ascertain the effect of thoracoplasty on pulmonary function.
Search was conducted according to PRISMA guidelines on three databases. After analysis of all the search results by title, abstracts and full texts-10 studies were identified for inclusion in the review. We included studies which had analyzed preoperative and postoperative pulmonary function tests (PFTs) after thoracoplasty. Pooled estimates were calculated for pulmonary function, and effect of other factors was analyzed by subgroup analysis and meta-regression.
The included studies were published between 1998 and 2019. A total of 385 patients were included in these studies, with a mean age of 15.01 years, with a female preponderance. Apprehension over appearance of rib hump was the most common indication for thoracoplasty. Percent-predicted forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV-1) were significantly decreased on follow-up. Anterior approach to corrective surgery and lower age were found to be associated with worse pulmonary function. Preoperative Cobb's angle was found to have significant impact on decrease in FEV-1 only, but not on other PFT parameters.
Overall decrease in pulmonary function after thoracoplasty necessitates the need of adequate preoperative pulmonary function to mitigate its effect on patient well-being. Use of a posterior approach for corrective surgery when thoracoplasty is planned might lead to better outcomes. More research is needed to study effect of preoperative Cobb's angle on pulmonary function.
胸廓成形术是一种从肋椎关节到肋结节畸形的顶点切除肋骨的手术，用于解决脊柱侧凸患者的美容问题。关于它对肺功能的影响，文献中存在争议。本荟萃分析旨在回顾和分析现有文献，确定胸廓成形术对肺功能的影响。
根据 PRISMA 指南，在三个数据库中进行了搜索。通过对标题、摘要和全文的分析，共确定了 10 项研究进行综述。我们纳入了分析胸廓成形术后术前和术后肺功能检查（PFT）的研究。对肺功能进行了汇总估计，并通过亚组分析和荟萃回归分析了其他因素的影响。
纳入的研究发表于 1998 年至 2019 年之间。这些研究共纳入 385 例患者，平均年龄为 15.01 岁，女性居多。对肋骨结节外观的担忧是最常见的胸廓成形术指征。预测百分比用力肺活量（FVC）和 1 秒用力呼气量（FEV-1）在随访时明显下降。矫正手术的前入路和较低的年龄与更差的肺功能相关。术前 Cobb 角仅与 FEV-1 下降显著相关，而与其他 PFT 参数无关。
胸廓成形术后肺功能总体下降，需要术前肺功能充足，以减轻对患者健康的影响。当计划进行胸廓成形术时，使用矫正手术的后入路可能会带来更好的结果。需要进一步研究术前 Cobb 角对肺功能的影响。
