Yang Scott, Gupta Apeksha, Trask Michael E, Maharaj Natalie M, Faino Anna V, Pirkle Sean, Adcock Kelson Roy, Bauer Jennifer M, Yaszay Burt, Redding Gregory
Seattle Children's Hospital, University of Washington, Seattle, Washington.
Core for Biostatistics, Epidemiology and Analytics in Research, Seattle Children's Research Institute, Seattle, Washington.
JB JS Open Access. 2025 Jul 24;10(3). doi: 10.2106/JBJS.OA.25.00120. eCollection 2025 Jul-Sep.
Longitudinal pulmonary outcomes after surgical treatment of early-onset scoliosis (EOS) are not well reported. This study aims to evaluate change in serial pulmonary function in children with EOS after surgery.
A retrospective review was performed at a single academic hospital. All patients who had surgical treatment of EOS and repeated pulmonary function test (PFT) data were included. Pulmonary function test (PFT) measures included forced vital capacity (FVC), FVC % of predicted norms (FVC%), forced expiratory volume in 1 second (FEV1), and FEV1% of predicted norms (FEV1%). To determine whether PFT changed postsurgery, a random-effects mixed model was used. Predicted marginal means of PFT measures were calculated, and Bonferroni adjusted p-values were reported. Spearman correlation was used to analyze the relationship between radiographic measures and PFTs.
Fifty-one patients with EOS were included (mean age 7.2 years at index surgery). The index distraction-based growth-friendly construct was 31 (60.8%) vertical expandable prosthetic titanium rib implants, 9 (17.6%) traditional growing rods, and 11 (21.6%) magnetically controlled growing rods; 23 patients (45%) underwent final fusion. The median duration from the first to the most recent PFT was 44 months. The random-effects model showed no significant change in FVC, FVC%, and FEV1 over time since surgery. When changes in PFTs were analyzed by scoliosis etiology, there was no significant change in PFT measures after surgical treatment with any etiology except in congenital scoliosis where both FVC% and FEV1% significantly decreased during growth-friendly treatment and fusion compared with before surgery. T1-T12 length significantly correlated moderately with FVC (rho = 0.46, p < 0.0001), but not FVC%. Major curve Cobb angle did not significantly correlate with PFT measures.
Growth-friendly EOS surgery did not improve pulmonary function, but at best prevented further pulmonary decline, except in children with congenital scoliosis who had worsening function over time.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
早发性脊柱侧弯（EOS）手术治疗后的长期肺部预后报道较少。本研究旨在评估EOS患儿术后系列肺功能的变化。
在一家学术医院进行回顾性研究。纳入所有接受EOS手术治疗且有重复肺功能测试（PFT）数据的患者。肺功能测试（PFT）指标包括用力肺活量（FVC）、预测正常值的FVC百分比（FVC%）、第1秒用力呼气量（FEV1）以及预测正常值的FEV1百分比（FEV1%）。为确定术后PFT是否发生变化，采用随机效应混合模型。计算PFT指标的预测边际均值，并报告经Bonferroni校正的p值。采用Spearman相关性分析影像学指标与PFT之间的关系。
纳入51例EOS患者（初次手术时平均年龄7.2岁）。基于撑开的生长友好型内固定器械中，31例（60.8%）为垂直可扩展人工钛肋骨植入物，9例（17.6%）为传统生长棒，11例（21.6%）为磁控生长棒；23例患者（45%）接受了最终融合手术。从首次到最近一次PFT的中位时间为44个月。随机效应模型显示，术后FVC、FVC%和FEV1随时间无显著变化。按脊柱侧弯病因分析PFT变化时，除先天性脊柱侧弯外，其他病因手术治疗后PFT指标均无显著变化，先天性脊柱侧弯患者在生长友好型治疗和融合过程中，FVC%和FEV1%较术前显著下降。T1 - T12长度与FVC中度显著相关（rho = 0.46，p < 0.0001），但与FVC%无显著相关性。主弯Cobb角与PFT指标无显著相关性。
生长友好型EOS手术未能改善肺功能，但至多可防止肺功能进一步下降，先天性脊柱侧弯患儿除外，其肺功能随时间恶化。
预后性III级。有关证据水平的完整描述，请参阅《作者须知》。
