重度脊柱畸形的肺功能特征及其影像学影响因素

Radiological factors influencing pulmonary function test in severe spinal deformity

目的 分析重度脊柱畸形的肺功能损害特征及其影响肺功能的相关影像学参数.方法 2009年9月至2014年12月,中山大学附属第一医院脊柱外科共66例符合入选标准的患者纳入研究.所有患者均行术前肺功能检查及站立位脊柱全长X线片,分析肺功能结果及其与脊柱影像学参数的相关性.结果 66例重度脊柱畸形患者中,57例（86.4％）合并有肺功能损害,其中54.6％为中重度肺功能损害[第1秒用力呼气容积（FEV1）≤59％],损害方式以限制性通气功能障碍为主.肺活量（VC）％、用力肺活量（FVC）％和FEV1％与主弯Cobb角、累及胸椎数目、累及椎体数目及局部后凸角呈显著负相关,而与顶椎位置呈显著正相关（顶椎越靠近头端,肺功能损害越严重）.多元线性回归分析显示,主弯Cobb角和累及胸椎数目是肺通气功能降低的主要影响因素,解释肺容积下降的46.2％ ～ 55.1％.结论 重度脊柱畸形多合并肺功能障碍,且以中重度限制性通气功能障碍为主.主弯Cobb角和受累胸椎数目是影响肺功能的主要因素.畸形越严重、节段越长、顶椎越靠头端的重度脊柱畸形患者,其肺功能损害越严重.

Objective To investigate the pulmonary dysfunction patterns in severe spinal deformity and to identify radiological factors affecting the pulmonary function.Methods From September 2009 to December 2014,a total of 66 patients were involved in this Department of Spine Surgery,The First Affiliated Hospital,Sun Yat-sen University.Preoperative pulmonary function testing （PFTs） and radiographic examination were performed on all of the involved patients.Correlation analysis and subsequent stepwise multiple regression analysis were carried out to assess the associations between radiographic measurements of deformity and the results of pulmonary function testing.Results Fifty-seven out of 66 patients had impaired pulmonary dysfunction,and more than half of were ≤59% predicted forced expiratory volume in 1 second （FEV1）.Most of the patients with severe spinal deformity demonstrated a restrictive pattern of pulmonary function.The magnitude of the major curve,the number of involved thoracic vertebrae had significant effect on pulmonary function.While these 2 factors were associated with an increased risk of pulmonary impairment,they explained only 46.2%-55.1% of the observed variability in vital capacity,forced vital capacity,and forced expiratory volume in one second.Conclusions Preoperative PFTs are clinically impaired in 86% of patients with severe spinal deformity,and more than half of that were moderate and severe pulmonary dysfunction.The magnitude of the major curve and the number of involved thoracic vertebrae are the main risk factors influencing the pulmonary dysfunction.