胸廓成形对脊柱侧凸患者后路矫形术后肺功能的影响

Pulmonary function after thoracoplasty and posterior correction in scoliosis

目的：探讨胸廓成形术对严重脊柱侧凸患者后路矫形手术后肺功能的影响。方法：我院脊柱外科2007年1月~2009年12月收治的30例胸弯Cobb角大于70°伴有肺功能障碍的脊柱侧凸且有完整资料的患者纳入本研究。男12例,女18例;年龄11~34岁,平均18.8±6.2岁;术前Cobb角70°~140°,平均101.0°±19.9°。所有患者均行后路矫形手术和凸侧胸廓成形术。术前、术后3个月和2年时应用肺功能检查（PFT）评估患者的肺功能状况,分析肺功能变化率与术后恢复时间的关系。结果：侧凸Cobb角矫正至53.0°±20.9°,平均矫正率为49.2%。随访3~24个月,平均12.8个月,与术前肺功能参数相比,术后3个月时患者的肺活量（VC）下降了15.0%,VC实测值与预计值的百分比（VC%）下降了15.8%,用力肺活量（FVC）下降了16.5%,FVC实测值与预计值的百分比（FVC%）下降了17.3%,第一秒用力呼气量（FEV1）下降了12.7%,FEV1实测值与预计值的百分比（FEV1%）下降了13.1%,与术前比较均有显著性差异（P〈0.05）。其中8例患者随访时间达到2年,末次随访时患者的肺功能参数略高于术前的基础水平,但无统计学差异（P〉0.05）。术后肺功能参数（VC、VC%、FVC、FVC%、FEV1、FEV1%）变化率均与手术后的恢复时间成正相关。结论：严重脊柱侧凸患者后路矫形同时进行胸廓成形术后肺功能在近期内会明显下降,但是随着恢复时间的延长,肺功能逐渐回到术前基础水平。

Objective：To investigate the pulmonary function after thoracoplasty and posterior correction in scoliosis.Method：From January 2007 to December 2009,A total of 30（12 males and 18 females） consecutive scoliosis patients with the Cobb angle over 70 degrees were recruited for this study.All patients with the mean age of 18.8±6.2 years old underwent posterior correction and thoracoplasty on the convex side.The absolute and percent predicted values of vital capacity（VC）,forced vital capacity（FVC）,and forced expiratory volume in 1 second（FEV1） were evaluated by pulmonary function test.All these PFT parameters were collected before and 3 to 24 months after correction.Result：After surgery,the coronal Cobb angles decreased from 101.0°±19.9°（range,70°-140°） to 53.0°±20.9° with a correction rate of 49.2%.At the 3th month follow-up,the absolute values of VC,FVC and FEV1 decreased 15.0%,16.5% and 12.7% respectively,while the percent predicted values of VC,FVC and FEV1 decreased 15.8%,17.3% and 13.1% respectively.All the parameters of the pulmonary function demonstrated a slight increase.8 cases with 2-year follow-up had parameters a little bit higher than preoperative baseline,with no statistical significance（P0.05）.The increased absolute values and percent-predicted values of these parameters were associated with recovery time after operation.Conclusion：The short-term pulmonary function decreases after thoracoplasty and posterior correction in scoliosis patients,however gradually returns to baseline with time going.