Shriners Children's-Philadelphia, Philadelphia, PA.
Columbia University, New York, NY.
Spine (Phila Pa 1976). 2024 May 1;49(9):E128-E132. doi: 10.1097/BRS.0000000000004926. Epub 2024 Jan 19.
Retrospective, single-center study.
To examine pulmonary function tests (PFTs) in patients undergoing anterior vertebral body tethering (AVBT).
The effect of AVBT on pulmonary status remains unclear.
The authors examined preoperative and postoperative PFTs following AVBT in a retrospective, single-center cohort of patients. Outcomes were compared using percent predicted values as continuous and categorical variables (using 10% change as significant) and divided into categorical values based on the American Thoracic Society standards.
Fifty-eight patients with adolescent idiopathic scoliosis were included, with a mean age of 12.5±1.4 years and a follow-up of 4.2±1.1 years. The mean thoracic curve was 47°±9°, which improved to 21°±12°. At baseline, the mean forced expiratory volume in one second (FEV1%) and forced vital capacity (FVC%) values were 79% and 82%, respectively. Four patients had normal FEV1% (≥100%), 67% had mild restrictive disease (70%-99%) and the rest had worse FEV1%. Mean FEV1 improved from 2.2 to 2.6 L ( P <0.05) and FVC improved from 2.5 to 3.0 L ( P <0.05); however, % predicted values remained unchanged (FEV1%: 79%-80%; FVC%: 82-80%, P >0.05) with mean postoperative PFTs at 37±12 months postoperative. The use of miniopen thoracotomy was not associated with worsening PFTs, but extension of the lowest instrumented vertebra below T12 was correlated with decreasing FEV1% in the bivariate analysis ( P <0.05). Patients with worse preoperative FVC% (80±13% vs. 90±11%, P =0.03) and FEV1% (77±17% vs. 87±12%, P =0.06) also had a greater likelihood of declining postoperative FEV1%.
Pulmonary function in most patients undergoing AVBT remained stable (76%) or improved (14%); however, a subset may worsen (10%). Further studies are needed to identify the risk factors for this group, but worse preoperative PFTs and extension below T12 may be risk factors for worsening pulmonary function.
回顾性、单中心研究。
检查接受前路椎体拴系术（AVBT）的患者的肺功能检查（PFT）。
AVBT 对肺功能的影响尚不清楚。
作者回顾性分析了单中心队列中接受 AVBT 的患者的术前和术后 PFT。使用预测百分比值作为连续和分类变量（以 10%的变化为显著）比较结果，并根据美国胸科学会标准分为分类值。
58 例青少年特发性脊柱侧凸患者纳入研究，平均年龄 12.5±1.4 岁，随访时间 4.2±1.1 年。平均胸椎曲度为 47°±9°，改善至 21°±12°。基线时，第 1 秒用力呼气量（FEV1%）和用力肺活量（FVC%）的平均值分别为 79%和 82%。4 例患者 FEV1%正常（≥100%），67%患者有轻度限制性疾病（70%-99%），其余患者有更严重的 FEV1 下降。平均 FEV1 从 2.2 升至 2.6L（P<0.05），FVC 从 2.5 升至 3.0L（P<0.05）；然而，预测百分比值保持不变（FEV1%：79%-80%；FVC%：82-80%，P>0.05），术后 37±12 个月的平均术后 PFT 值为 37±12 个月。微创开胸术的使用与 PFT 恶化无关，但最低器械椎骨在 T12 以下的延伸与双变量分析中 FEV1%的降低相关（P<0.05）。术前 FVC%（80±13%比 90±11%，P=0.03）和 FEV1%（77±17%比 87±12%，P=0.06）较差的患者术后 FEV1%下降的可能性也更大。
大多数接受 AVBT 的患者的肺功能保持稳定（76%）或改善（14%）；然而，有一部分患者可能会恶化（10%）。需要进一步研究来确定这一组的危险因素，但术前 PFT 较差和 T12 以下的延伸可能是肺功能恶化的危险因素。
