单一后路矫形术对严重脊柱侧凸肺功能的影响

Improvement of pulmonary function after posterior spinal correction in severe scoliosis patients

目的探讨单一后路矫形手术对严重脊柱侧凸患者肺功能恢复的影响。方法 2007～2009年间有完整肺功能资料的胸弯Cobb角>70°伴有肺功能障碍的严重脊柱侧凸患者30例纳入本次研究。患者年龄为10～36岁,平均17.0岁;其中男11例,女19例。使用肺功能检查评估患者术前和术后3个月、2年时的肺功能状况。结果患者术前平均Cobb角为109.1°,脊柱侧凸矫形术后Cobb角平均下降至65.6°,侧凸矫正率平均为43.0%。术后3个月患者肺功能有轻微的改善,与术前相比差异无统计学意义(P>0.05)。术后2年患者的肺活量(vital capacity,VC)升高了23.8%、VC与预计值的比升高了17.6%、用力肺活量(forced vital capacity,FVC)升高了23.6%、FVC与预计值的比升高了17.1%、1秒用力呼气量(forced expiratory volume in 1 s,FEV1)升高了25.6%,与术前相比差异有统计学意义(P<0.05);FEV1与预计值的比升高了21.9%,与术前相比差异无统计学意义(P>0.05)。患者术前肺功能参数与术前Cobb角成负相关,术后肺功能参数的改善率均与术前Cobb角成正相关。结论单一后路矫形手术可以有效的改善脊柱侧凸患者的肺功能,并随着术后时间的延长肺功能的改善越发显著,术前脊柱侧凸越严重术后肺功能的恢复效果也越明显。

Objective To assess the recovery of pulmonary function after posterior spinal correction in severe scoliosis patients.Methods From 2007 to 2009,30 severe scoliosis patients（Cobb＇s angle70°） with complete pulmonary function data,accompanied by pulmonary dysfunction,were enrolled in this study.There were 11 males and 19 females with an average age of 17.0 years（ranging from 10 to 36 years）.Pulmonary function was evaluated by pulmonary function test（PFT） before surgery,3 and 24 months after surgery.Results The average Cobb＇s angles decreased from preoperative 109.1° to postoperative 65.6° with a correction rate of 43.0%.All the parameters of the pulmonary function,such as vital capacity（VC）,forced vital capacity（FVC）,and forced expiratory volume in 1 s（FEV1）,demonstrated a slight increase with no statistical significance 3 months postoperatively（P0.05）.Two years after surgery,the absolute values of VC,FVC and FEV1 increased by 23.8%,23.6% and 25.6%,respectively;the percent-predicted values of VC,FVC and FEV1 increased by 17.6%,17.1% and 21.9%,respectively;compared with preoperation,the difference of PFT parameters,except for percent-predicted values of FEV1,had statistical significance after operation（P0.05）.There was a negative correlation between the preoperative PFT parameters and the Cobb＇s angles,and a positive correlation between the postoperative improvement rate of PFT parameters and preoperative Cobb＇s angles.Conclusion The pulmonary function of the scoliosis patients can be effectively improved by posterior spinal correction,and the pulmonary function increases along with time after surgery.The more severe scoliosis,the better recovery of pulmonary function.