强直性脊柱炎胸腰椎后凸畸形患者膈肌旋转与肺功能的相关性分析

The correlation between the diaphragmatic sagittal rotation and pulmonary dysfunction in ankylosing spondylitis kyphosis

目的 ：分析强直性脊柱炎（AS）胸腰椎后凸畸形患者膈肌矢状位旋转程度与肺功能的相关性。方法 ：以2011年6月~2014年1月在我院行截骨矫形术的AS胸腰椎后凸畸形患者30例为研究对象,术前均进行肺功能测定,肺功能参数包括：肺活量（lung volume capacity,VC）、每分钟通气量（minute ventilation volume,MVV）、用力肺活量（forced vital capacity,FVC）、第1秒最大呼气容积（forced expiratory volume in one second,FEV1）、第1秒最大呼气率（FEV1/FVC）、最大呼气流量（maximum expiratory flow volume,PEF）、补吸气量（inspiratory reserve volume,IRV）和补呼气量（expiratory reserve volume,ERV）,根据肺功能实测值计算所有肺功能指标占预计值的百分比;对其躯干进行术前三维CT重建,在正中矢状面上测量膈肌旋转角（diaphragm rotation angle,DA）和T1-S1 Cobb角,应用相关软件对正中矢状面上测量的DA和术前T1-S1 Cobb角及肺功能参数进行相关性分析。结果：手术前30例患者的VC为（68.26±6.78）%,MVV为（56.71±6.90）%,FVC为（69.10±6.34）%,FEV1为（43.24±5.67）%,FEV1/FVC为（46.48±3.81）%,PEF为（78.07±11.91）%,IRV为（54.85±6.37）%,ERV为（63.37±19.73）%;DA为-28.18°±9.67°,T1-S1 Cobb角为49.17°±7.43°。DA与T1-S1 Cobb角呈负相关（r=-0.5337,P〈0.05）,与VC和FVC、PEF、IRV、ERV呈正相关（r=0.6184、0.3893、0.4966、0.3732、0.3633,P〈0.05）,与FEV1、FEV1/FVC和MVV无显著相关性（P〉0.05）。结论 ：AS胸腰椎后凸畸形患者膈肌在矢状位上的旋转程度随后凸程度的增加而加重,肺功能随膈肌旋转程度增加而下降。

Objectives： To analyse the correlation between the pulmonary dysfunction patterns and the diaphragmatic sagittal rotation in AS thoracolumbar kyphosis. Methods： From June 2011 to January 2014, 30 patients in our department with thoracolumbar kyphotic deformity secondary to ankylosing spondylitis and un-dergoing pedicle subtraction osteotomy were reviewed retrospectively. The pulmonary function tests were per-formed preoperatively including： lung volume capacity（VC）, minute ventilation volume（MVV）, forced vital capac-ity（FVC）, forced expiratory volume in one second（FEV1）, FEV1/FVC, maximum expiratory flow volume（PEF）,inspiratory reserve volume（IRV）, expiratory reserve volume（ERV）. The percentage of all lung function indexes was measured according to the results. All the patients had computed tomographic scan and three dimensional reconstruction, full-length spine radiographs. The diaphragm angle（DA） and T1-S1 Cobb angle on median sagittal plane were measured. The Pearson coefficient was used to evaluate the correlation between DA and pulmonary function and the T1-S1 Cobb angle, respectively. Results： The VC value was（68.26±6.78）%, MVV value was（56.71±6.90）%, FVC value was（69.10±6.34）%, FEV1 value was（43.24 ±5.67）%, FEV1/FVC value was（46.48±3.81）%, PEF value was（78.07±11.91）%, IRV value was（54.85±6.37）%, ERV value was（63.37±19.73）%; DA was-28.18°±9.67°, T1-S1 Cobb angle was 49.17°±7.43°. The data analysis presented a negative correlation between DA value and the Cobb T1-S1（r=-0.5337, P〈0.05）. There was also positive correlations between the DA value and VC, FVC, ERV, IRV and PEF（r=0.6184, 0.3893, 0.4966, 0.3732, 0.3633; P〈0.05）. There was no significant correlations between the DA value and FEV1, FEV1/FVC and MVV（P〉0.05）.Conclusions： Diaphragm rotate more severely with the Cobb T1-S1 increasing; the diaphragmatic sagittal rotation is also a aggravating factor of pulmonary dysfunction in AS patients with kyphosis.