青少年Chiari畸形伴脊柱侧弯与特发性脊柱侧弯患者肺功能损害的特征

Comparison of the pulmonary function between adolescent patients with Chiari malformationassociated scoliosis and idiopathic scoliosis

目的比较青少年Chiari畸形伴脊柱侧弯（CMS）与青少年特发性脊柱侧弯（AIS）患者肺功能损害的特征。方法回顾性分析2010年6月至2016年6月南京医科大学鼓楼临床医学院脊柱外科52例手术治疗的CMS患者（CMS组）的临床及影像学资料，同时选取年龄、性别、Cobb角匹配的52例AIS患者作为对照（AIS组）。术前测量两组患者的肺功能，包括：肺活量（VC）、用力肺活量（FVC）、第1秒用力呼气容积（FEV．）、最大呼吸中期流量（MMEF）实测值以及这些值占预计值的百分比（预计值％）和FEV．／FVC值；分析两组肺功能参数的异同；并对CMS患者肺功能损害的影像学因素进行分析。结果两组性别、年龄、胸弯Cobb角等基线资料相似。CMS组和AIS组分别有42例（80．7％）和44例（84．6％）存在限制性通气功能障碍（FVC预计值％〈80％），其中分别有18例（42．8％）和10例（22．7％）合并有阻塞性通气功能障碍（FEV．／FVC〈92％）；两组通气功能障碍类型分布差异无统计学意义（P〉0．05）。CMS与AIS组间VC预计值％、FVC预计值％、FEV，预计值％及FEV．／FVC差异均无统计学意义（均JP〉0．05）。CMS组MMEF预计值％略低于AIS组[（57．9±13．3）％比（67．2±23．3）％，P=0．053]。胸弯累及椎体数与VC预计值％、FVC预计值％、FEV。预计值％和MMEF预计值％均呈负相关（均P〈0．01）；Cobb角与VC预计值％、FVC预计值％、FEV，预计值％均呈负相关（均P〈0．05）；胸椎后凸与VC预计值％、FVC预计值％和FEV．预计值％均呈正相关（均P〈0．05）。结论不合并明显神经损害的青少年CMS患者和AIS患者在肺功能损害特征上无显著差异，皆表现为限制性为主的通气功能障碍。

Objective To compare the pulmonary function between adolescent patients with Chiari malformation associated seoliosis （CMS） and adolescent idiopathic seoliosis （AIS）. Methods A retrospective analysis was performed on 52 patients with CMS, and 52 patients with AIS were selected as the control group to match the CMS patients by age, sex, and Cobb angle. Preoperative pulmonary function tests were completed by all the patients, including vital capacity （ VC ）, forced vital capacity （ FVC ）, forced expiratory volume in one second （ FEV1 ） , maximal mid-expiratory flow （MMEF） , and ratio of FEV1 to FVC. The difference of pulmonary function parameters was analyzed between the two groups; Correlation between pulmonary function and radiographic parameters was analyzed in patients with CMS. Results There were no significant differences in terms of sex, age, and the main coronal Cobb angle between the two groups. There were 42 （ 80. 7% ） and 44 （ 84. 6% ） of patients with restrictive ventilatory dysfunction （ the percentage of predicted FVC 〈80% ） in CMS and AIS group respectively. 18（42. 8% ） and 10 （22. 7% ） out of these patients were also with obstructive ventilation dysfunction （FEV1/FVC 〈 92% ） in CMS and AIS group respectively. Types of ventilation dysfunction distributed between the two groups had no significant difference （P 〉0. 05 ）. No significant difference was noted between the two groups in the percentage ofpredicted VC, FVC, FEV1 and FEV1/FVC （ P 〉 O. 05 ）. The percentage of predicted MMEF in patients with CMS was lower compared to those with AIS（57.9 ± 13.3）% vs （67.2 ±23.3）%, P=0.053]. In patients with CMS, the percentage of predicted VC, FVC, FEV1 and MMEF had significantly negative correlation with the number of vertebrae involved （P 〈 O. O1 ）. Main coronal Cobb angle had negative correlation with the percentage of predicted VC, FVC and FEV （ P 〈 0. 05 ）. The percentage of predicted VC, FVC and FEV had positive correlation with thoracic kyphosis （P 〈 O. 05）. Conclusions There are no significant differences in characteristics of the pulmonary dysfunction between patients with AIS and CMS without obviously neural deficit. Both groups mainly present with restrictive ventilation dysfunction.