Kearon C, Viviani G R, Kirkley A, Killian K J
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Am Rev Respir Dis. 1993 Aug;148(2):288-94. doi: 10.1164/ajrccm/148.2.288.
Adolescent idiopathic thoracic scoliosis may lead to severe pulmonary impairment and early death, but the responsible factors are poorly understood; pulmonary function is only weakly related to the angle of scoliosis. We performed a cross-sectional study using multivariate analysis to identify the individual and additive influence of different features of spinal deformity and nonstructural factors on pulmonary impairment. Pulmonary function was assessed by measuring lung volumes and diffusing capacity, with a priori selection of vital capacity (expressed as percentage of predicted, % VC) as the primary index of pulmonary impairment. Radiologic and physiologic measurements were made independently in 66 subjects who had not previously had spinal surgery. Angle of scoliosis (p = 0.01) was one of four features of spinal deformity associated with reduced % VC; greater number of vertebrae involved (p = 0.007), cephadal location of the curve (p = 0.04), and loss of the normal thoracic kyphosis (p = 0.002) made an equal and additive contribution to pulmonary impairment. Spinal deformity led to reductions in VC, primarily by reducing TLC. Spinal column rotation, respiratory muscle strength, and duration of the curvature were not related to pulmonary function (p > 0.05). We conclude that features of the spinal deformity are the major determinants of pulmonary impairment in idiopathic thoracic scoliosis but that the relationship between deformity and impairment is complex. The severity of pulmonary impairment cannot be inferred to a clinically useful extent from the angle of scoliosis alone.
青少年特发性胸段脊柱侧弯可能导致严重的肺功能损害和过早死亡，但相关因素尚不清楚；肺功能与脊柱侧弯角度仅有微弱关联。我们进行了一项横断面研究，采用多变量分析来确定脊柱畸形的不同特征及非结构性因素对肺功能损害的个体及累加影响。通过测量肺容量和弥散能力评估肺功能，预先选择肺活量（以预测值的百分比表示，%VC）作为肺功能损害的主要指标。对66例未曾接受过脊柱手术的受试者独立进行影像学和生理学测量。脊柱侧弯角度（p = 0.01）是与%VC降低相关的脊柱畸形的四个特征之一；受累椎体数量增多（p = 0.007）、侧弯的头侧位置（p = 0.04）以及正常胸段后凸消失（p = 0.002）对肺功能损害有同等且累加的影响。脊柱畸形导致肺活量降低，主要是通过降低肺总量。脊柱旋转、呼吸肌力量和侧弯持续时间与肺功能无关（p > 0.05）。我们得出结论，脊柱畸形特征是特发性胸段脊柱侧弯肺功能损害的主要决定因素，但畸形与损害之间的关系很复杂。仅从脊柱侧弯角度无法在临床上有用的程度推断肺功能损害的严重程度。
