Halo骨盆牵引联合后路矫正治疗重度僵硬型脊柱侧弯后肺功能及三维重建肺容积的改善：一项多中心研究

Improvement of Pulmonary Function and Reconstructed 3-Dimensional Lung Volume After Halo-Pelvic Traction Combined With Posterior Correction for Severe Rigid Spinal Scoliosis: A Multicenter Study.

作者信息

Liu Zhiming, Zhong Junlong, Ma Shengbiao, Yang Cao, Wan Wenbing, Wan Zongmiao, Mamat Mardan, Wang Yingsong, Ge Zhaohui, Cao Kai

机构信息

The Orthopedic Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China.

Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

出版信息

Neurosurgery. 2023 Nov 22. doi: 10.1227/neu.0000000000002779.

DOI:10.1227/neu.0000000000002779

PMID:37991353

Abstract

BACKGROUND AND OBJECTIVES

Severe rigid spinal scoliosis (SRSS) leads to severe restrictive ventilation dysfunction. Currently, the reports about the influence of preoperative halo-pelvic traction (HPT) combined with correction surgery on pulmonary function in patients with SRSS were relatively few. This study aims to investigate (1) the influence of preoperative HPT on lung volume and pulmonary function, (2) the further influence of the following correction surgery on lung volume and pulmonary function, and (3) the relationship among deformity correction, pulmonary function test outcomes, and computed tomography-based lung volume.

METHODS

A total of 135 patients with SRSS who underwent preoperative HPT and followed low-grade osteotomy correction surgery were reviewed. Spinal parameters, including proximal thoracic curve, main thoracic curve (MTC), lumbar curve, coronal balance, thoracic kyphosis, lumbar lordosis, sagittal vertical axis, pulmonary function test outcomes (forced vital capacity [FVC], the percentage of predicted forced vital capacity [FVC%], forced expiratory volume in 1 second [FEV1], total lung capacity [TLC]), and lung volume (Vin), were analyzed before, after HPT and at the final follow-up, respectively.

RESULTS

The mean FVC, FVC%, FEV1, and TLC increased from 1.67 L, 51.13%, 1.47 L, and 2.37 L to 1.95 L, 64.35%, 1.75 L, and 2.78 L, respectively, after HPT and further improved to 2.22 L, 72.14%, 1.95 L, and 3.15 L, respectively, at the final follow-up. The mean Vin increased from 1.98 L to 2.42 L after traction and further increased to 2.76 L at the final follow-up. The variation of MTC was correlated with the improvement of FVC (r = 0.429, P = .026), FVC% (r = 0.401, P = .038), FEV1 (r = 0.340, P = .043), and TLC (r = 0.421, P = .029) and the variation of Vin (r = 0.425, P = .015) before HPT and after surgery.

CONCLUSION

Preoperative HPT can improve preoperative pulmonary function and enhance the preoperative lung volume. There were significant correlations among the variations of MTC, pulmonary function indexes, and lung volume before HPT and after surgery in patients with SRSS.

摘要

背景与目的

重度僵硬性脊柱侧凸（SRSS）会导致严重的限制性通气功能障碍。目前，关于术前头盆牵引（HPT）联合矫正手术对SRSS患者肺功能影响的报道相对较少。本研究旨在探讨：（1）术前HPT对肺容积和肺功能的影响；（2）后续矫正手术对肺容积和肺功能的进一步影响；（3）畸形矫正、肺功能测试结果与基于计算机断层扫描的肺容积之间的关系。

方法

回顾性分析135例行术前HPT并接受低位截骨矫正手术的SRSS患者。分别在HPT前、HPT后及末次随访时分析脊柱参数，包括近端胸椎侧弯、主胸弯（MTC）、腰椎侧弯、冠状面平衡、胸椎后凸、腰椎前凸、矢状垂直轴、肺功能测试结果（用力肺活量[FVC]、预测用力肺活量百分比[FVC%]、第1秒用力呼气容积[FEV1]、肺总量[TLC]）以及肺容积（Vin）。

结果

HPT后，平均FVC、FVC%、FEV1和TLC分别从1.67L、51.13%、1.47L和2.37L增加至1.95L、64.35%、1.75L和2.78L，末次随访时进一步改善至2.22L、72.14%、1.95L和3.15L。牵引后平均Vin从1.98L增加至2.42L，末次随访时进一步增加至2.76L。术前及术后，MTC的变化与FVC（r = 0.429，P = .026）、FVC%（r = 0.401，P = .038）、FEV1（r = 0.340，P = .043）、TLC（r = 0.421，P = .029）以及Vin的变化（r = 0.425，P = .015）相关。