Rawlins B A, Winter R B, Lonstein J E, Denis F, Kubic P T, Wheeler W B, Ozolins A L
Minnesota Spine Center, Minneapolis 55454-1419, USA.
J Pediatr Orthop. 1996 May-Jun;16(3):284-92. doi: 10.1097/00004694-199605000-00002.
Thirty-two pediatric patients with severe restrictive lung disease identified with vital capacities < 40% of predicted, who had undergone major reconstructive spine surgery, were reviewed. There were 18 boys and 14 girls, the mean age was 13 years (range, 7-17), and the mean vital capacity was 31% of predicted (range, 16-39%). Fifty-four procedures were performed, 13 posterior only, one of which was staged, and 19 anterior and posterior procedures, of which 15 were staged and four were sequential. The incidence of pulmonary complications (pneumonia, reintubation, pneumothorax, respiratory arrest, or the need for tracheostomy) was 19% (six patients), and only three patients required tracheostomy. The surgical and perioperative mortality rate was zero. Patients who had a thoracotomy or a thoracoabdominal approach had a significantly higher number of pulmonary complications. The use of preoperative decreased vital capacity as a measure of inoperability excludes the young patient most in need of surgical intervention. With improved preoperative, intraoperative, and postoperative techniques, careful monitoring, and the cooperation of pediatric pulmonologists and intensivists, reconstructive spine surgery can be performed in the pediatric patient with severe decreased vital capacity with very acceptable morbidity and mortality.
回顾了32例严重限制性肺病的儿科患者，这些患者肺活量低于预测值的40%，且均接受了脊柱重建大手术。其中有18名男孩和14名女孩，平均年龄为13岁（范围7 - 17岁），平均肺活量为预测值的31%（范围16 - 39%）。共进行了54次手术，13次仅为后路手术，其中1次为分期手术，19次为前后路联合手术，其中15次为分期手术，4次为连续手术。肺部并发症（肺炎、再次插管、气胸、呼吸骤停或需要气管切开术）的发生率为19%（6例患者），只有3例患者需要气管切开术。手术及围手术期死亡率为零。接受开胸手术或胸腹联合手术的患者肺部并发症明显更多。将术前肺活量降低作为手术不可行的衡量标准会排除最需要手术干预的年轻患者。随着术前、术中和术后技术的改进、仔细的监测以及儿科肺科医生和重症监护医生的合作，对于肺活量严重降低的儿科患者，可以进行脊柱重建手术，且发病率和死亡率都非常可观。
