重度僵硬性特发性脊柱侧凸患者术后肺功能变化

PULMONARY FUNCTION CHANGES AFTER OPERATION IN PATIENTS WITH SEVERE SCOLIOSIS

目的探讨前路松解、后路矫形、凸侧短段肋骨切除胸廓成形术对重度僵硬性特发性脊柱侧凸患者肺功能的影响。方法2006年1月-2007年7月,对16例重度僵硬性特发性脊柱侧凸患者行前路松解、后路矫形、凸侧短段肋骨切除胸廓成形术。其中男6例,女10例;年龄10～24岁,平均16.9岁。Lenke分型:1型1例,2型9例,4型6例。术前侧凸Cobb角(104.8±10.9)°,胸段后凸Cobb角(30.0±4.2)°,剃刀背高度(5.9±1.2)cm。患者术前用力肺活量(forcedvitalcapacity,FVC)和第1秒用力呼气容积(forcedexpiratoryvolumein1second,FEV1.0)实测值分别为(2.04±0.63)L和(1.72±0.62)L,实测值占预计值的百分比分别为70%±16%及67%±15%。术后3、6、12、24个月复查肺功能,了解肺功能变化情况。结果术后切口均Ⅰ期愈合。术后24个月随访,侧凸Cobb角(53.4±18.6)°,矫正率49.0%±15.3%;胸段后凸Cobb角(34.0±2.4)°,矫正率13.3%±2.2%;剃刀背高度(2.2±0.8)cm;以上指标与术前比较差异均有统计学意义(P<0.05)。术后3、6个月,FVC和FEV1.0实测值较术前下降,但差异无统计学意义(P>0.05);术后12及24个月,FVC和FEV1.0实测值接近术前(P>0.05)。术后3～24个月,FVC及FEV1.0实测值占预计值的百分比持续改善,与术前相比,术后3个月FVC下降19%,FEV1.0下降16%,差异均有统计学意义(P<0.05);术后6个月,FVC下降12%,FEV1.0下降10%,差异均有统计学意义(P<0.05);术后12、24个月,FVC及FEV1.0接近术前,差异无统计学意义(P>0.05)。结论采用前路松解、后路矫形、凸侧短段肋骨切除胸廓成形术治疗重度僵硬性特发性脊柱侧凸,术后3～6个月患者肺功能下降明显,但术后12～24个月恢复至术前水平。

Objective To evaluate pulmonary function changes in patients with severe scoliosis undergoing anterior release,posterior segmental fixation and fusion,and convex thoracoplasty by resecting a short length of rib.Methods From January 2006 to July 2007,16 patients with severe scoliosis were treated with anterior release,posterior segmental fixation and fusion,and convex thoracoplasty by resecting a short length of rib.There were 6 males and 10 females with an average age of 16.9 years（range,10-24 years）.There were 1 case of Lenke 1 curve,9 cases of Lenke 2 curve,and 6 cases of Lenke 4 curve.The preoperative Cobb angle was（104.8±10.9）°and the preoperative thoracic kyphotic angle was（30.0±4.2）°.The preoperative height of＂razor back＂deformity was（5.9±1.2）cm.Before operation,the actual value of forced vital capacity（FVC）was（2.04± 0.63）L and that of forced expiratory volume in 1 second（FEV1.0）was（1.72±0.62）L.The percentage of actual values to expected ones in FVC was 70%±16%,and that in FEV1.0 was 67%±15%.All patients had pulmonary function tests before operation and 3,6,12,24 months after operation.Results All wounds healed by first intention.The Cobb angle at 24-month follow-up was（53.4±18.6）°and the correction rate was 49.0%±15.3%.The thoracic kyphotic angle at 24-month follow-up was（34.0± 2.4）°and the correction rate was 13.3%±2.2%.The height of＂razor back＂deformity at 24-month follow-up was（2.2±0.8）cm. Compared with preoperative level,all these data showed significant differences（P0.05）.At 3 and 6 months,the actual values of FVC and FEV1.0 declined,but no significant difference was found（P0.05）.At 12 and 24 months,the actual values of FVC and FEV1.0 were close to the preoperative level（P0.05）.The percentages of actual values to expected ones in FVC and FEV1.0 indicate continued improvement in pulmonary function from the postoperative 3 to 24 months follow-up.Compared with preoperative level,the percentages of actual values in FVC declined 19%3 months postoperatively（P0.05）and 12%6 months postoperatively （P0.05）.The percentages of actual values to expected ones in FEV1.0 declined 16%3 months postoperatively（P0.05）,and 10%6 months postoperatively（P0.05）.The percentages of actual values to expected ones in FVC and FEV1.0 were close to the preoperative level 12 and 24 months after operation（P0.05）.Conclusion In severe scoliosis patients who are treated with anterior release,posterior segmental fixation and fusion,and convex thoracoplasty by resecting a short length of rib,pulmonary function decreases obviously 3-6 months after operation.And it returns to the operative baseline 12-24 months after operation.