University of Texas Southwestern Medical School, Dallas, TX, USA.
Scottish Rite for Children, 2222 Welborn St., Dallas, TX, 75219, USA.
Spine Deform. 2023 Jul;11(4):943-950. doi: 10.1007/s43390-023-00681-2. Epub 2023 Apr 12.
This study aims to examine pulmonary function outcomes in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF) with an anterior thoracoscopic release compared to those undergoing PSF alone.
A retrospective review of patients with AIS over a 9-year period at a single institution compared 2 groups: PSF with video-assisted thoracoscopic surgery (PSF/VATS) and patients undergoing a posterior spinal fusion (PSF) alone. Standard radiographs and Forced Expiratory Volume (FEV) and Forced Vital Capacity (FVC) were obtained preoperatively and at regular follow up periods up to 2-year post-operatively. Within group and between-group comparisons were performed.
There were 110 patients in the study: 12 in the PSF/VATS cohort and 98 in the PSF only cohort. The PSF/VATS group were younger (12.6 vs. 14.6, p = 0.003) and had larger coronal curves (80.8° vs. 60.7°, p = 0.001), and worse preoperative FVC (64.7% vs. 79.6%, p = 0.018) and FEV (62.3% vs. 77.6%, p = 0.003). At 2 years, the percent coronal Cobb correction was greater in the PSF/VATS group (67.9% vs. 48.4%, p < 0.001) with greater improvement in thoracic height (32.8 mm vs. 20.7 mm, p = 0.028). While the 2-year PFTs were the same for FEV% (75.8% vs. 81.8%, p = 0.368) and FVC% (77.3% vs. 83.7%, p = 0.562), there was greater percent improvement over the 2 years in the PSF/VATS cohort: FEV% (13.5% vs. 4.2%, p = 0.082) and FVC% (12.7% vs. 4.1%, p = 0.112).
AIS patients who have a VATS approach in addition to PSF have greater coronal plane correction and improved pulmonary function compared to PSF alone despite more severe spinal deformity and worse baseline pulmonary function.
本研究旨在比较青少年特发性脊柱侧凸（AIS）患者接受后路脊柱融合术（PSF）联合前路胸腔镜松解术（PSF/VATS）与单纯 PSF 术后的肺功能结局。
回顾性分析了一家医疗机构 9 年内的 AIS 患者，比较了 2 组患者：PSF/VATS 组和单纯 PSF 组。术前及术后定期随访至 2 年，均获得标准 X 线片和用力肺活量（FEV）和用力肺活量（FVC）。进行了组内和组间比较。
研究共纳入 110 例患者：PSF/VATS 组 12 例，单纯 PSF 组 98 例。PSF/VATS 组年龄较小（12.6 岁 vs. 14.6 岁，p=0.003），冠状面曲线较大（80.8° vs. 60.7°，p=0.001），术前 FVC （64.7% vs. 79.6%，p=0.018）和 FEV （62.3% vs. 77.6%，p=0.003）较差。2 年时，PSF/VATS 组的冠状面 Cobb 角矫正百分比更大（67.9% vs. 48.4%，p<0.001），胸椎高度改善更大（32.8mm vs. 20.7mm，p=0.028）。虽然 2 年后 FEV%（75.8% vs. 81.8%，p=0.368）和 FVC%（77.3% vs. 83.7%，p=0.562）相同，但 PSF/VATS 组 2 年内 FEV%（13.5% vs. 4.2%，p=0.082）和 FVC%（12.7% vs. 4.1%，p=0.112）的改善百分比更大。
与单纯 PSF 相比，AIS 患者在接受 PSF 基础上增加胸腔镜辅助手术可获得更大的冠状面矫正，并改善肺功能，尽管脊柱畸形更严重，基础肺功能更差。
