Oba Hiroki, Ikegami Shota, Uehara Masashi, Hatakenaka Terue, Kamanaka Takayuki, Miyaoka Yoshinari, Kurogouchi Daisuke, Fukuzawa Takuma, Mimura Tetsuhiko, Koseki Michihiko, Takahashi Jun
Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
Faculty of Textile Science and Technology, Shinshu University, Ueda, Nagano, Japan.
Spine Surg Relat Res. 2022 Oct 13;7(1):52-59. doi: 10.22603/ssrr.2022-0120. eCollection 2023 Jan 27.
Corrective scoliosis surgery in patients with adolescent idiopathic scoliosis (AIS) increases thoracic volume but does not improve respiratory function (RF). This study evaluates the effect of physical flexibility (PF) improvement after scoliosis surgery on RF.
This study reviewed the records of 61 consecutive patients with AIS (56 female and 5 male; mean±standard deviation age: 14.8±2.2 years, range: 11-20 years) who had undergone posterior spinal fusion (PSF) of the thoracic curve. PF evaluated as finger-floor distance (FFD) was measured preoperatively and one year after surgery. After dividing the cohort into the PF improvement group and the PF nonimprovement group, RF changes at two years postoperative were statistically compared. Using logistic regression analysis, we evaluated the impact of a PF improvement on % forced vital capacity (%FVC) two years after surgery.
The rate of patients with increased FVC, %FVC, and forced expiratory volume 1.0 second two years after surgery was 79%, 51%, and 80%, respectively. The PF improvement group exhibited a significantly higher gain in %FVC versus the PF nonimprovement group (P=0.043). Moreover, PF improvement significantly prevented a %FVC decrease (odds ratio 8.43, 95% confidence interval 1.92-59.70; P<0.001), with an adjusted odds ratio of 11.86 (P<0.001).
Patients with diminished PF after PSF for AIS may be less likely to achieve postoperative %FVC improvement. As increased postsurgical %FVC had a positive effect on physical function, treatment strategies that focus on maintaining and increasing PF are desirable from an RF viewpoint.
青少年特发性脊柱侧凸（AIS）患者的矫正性脊柱侧凸手术可增加胸廓容积，但不能改善呼吸功能（RF）。本研究评估脊柱侧凸手术后身体柔韧性（PF）改善对呼吸功能的影响。
本研究回顾了61例连续接受胸椎后路脊柱融合术（PSF）的AIS患者（56例女性，5例男性；平均±标准差年龄：14.8±2.2岁，范围：11 - 20岁）的记录。术前及术后一年测量以指尖距地面距离（FFD）评估的PF。将队列分为PF改善组和PF未改善组，对术后两年的呼吸功能变化进行统计学比较。使用逻辑回归分析，我们评估了PF改善对术后两年用力肺活量百分比（%FVC）的影响。
术后两年用力肺活量（FVC）、%FVC和第1秒用力呼气量增加的患者比例分别为79%、51%和80%。与PF未改善组相比，PF改善组的%FVC增加显著更高（P = 0.043）。此外，PF改善显著预防了%FVC下降（优势比8.43，95%置信区间1.92 - 59.70；P < 0.001），调整后的优势比为11.86（P < 0.001）。
AIS患者PSF后PF降低的患者术后%FVC改善的可能性可能较小。由于术后%FVC增加对身体功能有积极影响，从呼吸功能角度来看，关注维持和增加PF的治疗策略是可取的。
