成人胸段侧凸患者心脏结构和功能的研究

Retrospective research of cardiac structure and function in patients with adult scoliosis

目的分析成人胸段侧凸患者心脏结构和功能的特点并探讨使其发生改变的影响因素。方法回顾分析41例主弯为胸弯的成人脊柱侧凸患者的心脏彩色超声以及与脊柱侧凸相关的临床、影像学资料，男9例，女32例；年龄22-57岁，平均31．29岁。对照组为椎间盘突出症患者35例，男7例，女28例；年龄25-44岁，平均31．17岁。研究侧凸方向、侧凸角、侧凸累及椎体数量、侧凸弧度类型、顶椎位置以及年龄对成人脊柱侧凸患者心脏结构和功能的影响。结果侧凸角和侧凸累及椎体的数量分别影响心脏舒张功能（E／A比值）和收缩功能（左室短轴缩短率）。此外，侧凸弧度类型以及顶椎位置影响成人脊柱侧凸患者的主肺动脉径。成人侧凸组患者与对照组患者之间舒张末期室间隔厚度、舒张末期左室后壁厚度、舒张末期左室前后径、收缩末期左室前后径、左房前后径、右室前后径、主动脉根径、主肺动脉径等心脏结构指标存在显著性差异。结论成人胸段侧凸患者的心脏结构和功能指标总体并未偏离正常范围，但是脊柱畸形仍对患者的心脏结构和舒缩功能产生一定影响。主要影响因素可能包括侧凸角、侧凸累及椎体数量、侧凸弧度类型以及顶椎位置。

Objective To investigate the features of the cardiac structure and function in patients with adult scoliosis. Methods The preoperative reports of cardiac ultrasound and imaging data of 41 patients with adult scoliosis were retrospectively, which included 9 males, 32 females, with the mean age of 31.29 years （range, 22-57 years）. Another 35 patients with intervertebral herniation were set up control group, which included 7 males, 28 females, with the mean age of 31.17 years （range, 25-44 years）. Parameters related to cardiac structure and function were compared according to Cobb angle in coronal plane, the number of vertebrate involved, type of radian, location of the apex vertebrate and age. Results E/A value and fractional shortening were affected by the degree of the scoliosis and the number of vertebrae involved respectively. Furthermore, diameter of arteria pulmonalis was influenced by the type of radian and location of apex vertebrate. There were significant differences in interventricular septum thickness in diastole, left ventricular posterior wall thickness in diastole, left ventricular internal diameter in end diastole, left ventricular internal diameter in end systole, left atrial dimension, right ventricular dimension, diameter of aortic root and diameter of arteria pulmonalis between scoliosis group and control group. Conclusion Patients with adult scoliosis have no significant abnormality in cardiac structure and function. However, spinal deformities still exert certain effect on cardiac structure and function. The main factors may consist of Cobb angle in coronal plane, the number of vertebrate involved, type of radian and location of the apex vertebrate.