肋骨畸形对中度先天性脊柱侧凸患者肺功能的影响

The effect of the rib deformity on the pulmonary dysfunction in moderate congenital scoliosis

目的:探讨不同程度肋骨畸形对中度先天性脊柱侧凸(CS)患者肺功能的影响。方法:回顾性分析我院2008年1月~2016年12月收治的108例中度CS(胸弯Cobb角40°~70°)患者的临床资料,其中男性49例,女性59例,年龄10~18岁,平均13.5±2.1岁。根据患者肋骨畸形的形态特征及范围将患者分为三组。无畸形组,无肋骨畸形;简单畸形组,有1~2根肋骨数目改变或2~3根肋骨局部融合或分叉;复杂畸形组,3根以上肋骨融合或分叉,或出现胸壁缺损。测量三组患者的影像学及肺功能参数。影像学参数包括:侧凸Cobb角、胸椎后凸角、胸弯累及椎体数、胸廓高度、胸廓横径;肺功能参数包括:肺活量(VC)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、最大通气量(MVV)实测值以及实测值占预计值的百分比(实/预)和FEV1/FVC值。对各组影像学参数和肺功能参数的差异进行分析。同时采用卡方检验对各组患者肺功能损害程度和损害模式分布进行分析。结果:三组患者影像学参数(胸弯Cobb角、胸弯后凸角、胸弯累及椎体节段数、胸廓高度、胸廓横径等)均无统计学差异(P>0.05)。三组患者中简单畸形组和无畸形组相比,肺功能无显著差异[VC:(81.88±11.11)%vs(78.22±8.49)%;FVC:(81.66±9.72)%vs (78.35±6.74)%;FEV1:(79.50±10.18)%vs (75.73±8.44)%;MVV:(79.10±12.48)%vs (75.04±7.21)%,P>0.05]。而复杂畸形组患者肺功能明显比无畸形组较差[VC:(64.68±10.00)%vs (78.22±8.49)%,P=0.012;FVC:(64.61±10.57)%vs (78.35±6.74)%,P<0.001;FEV1:(59.57±10.16)%vs (75.73±8.44)%,P<0.001;MVV:(62.82±12.02)%vs (75.04±7.21)%,P=0.014]。无畸形组和简单畸形组患者肺功能损害程度无统计学差异,均以轻度及中度肺功能障碍患者为主(χ^2=1.314,P=0.532);而在复杂畸形组中,则以中度及重度肺功能障碍患者居多(χ^2=40.1,P<0.001)。三组CS患者肺功能损害类型均以混合性通气功能障碍为主(χ^2=6.4,P=0.202)。结论:对于中度CS患者,简单肋骨畸形对肺功能的影响与无畸形组相比无显著差异,而复杂肋骨畸形与其他两组相比对于肺功能的影响较大,其肺功能损害程度以中重度肺功能障碍为主,肺功能损害类型方以混合性通气功能障碍为主。

Objectives: To investigate the effects of different types of rib deformity associated with moderate congenital scoliosis on the pulmonary dysfunction. Methods: A total of 108 adolescent patients(49 males and59 females, mean age 13.5±2.1 years) with moderate thoracic CS(thoracic cobb angle 40°-70°) in our hospital from January 2008 to December 2016 was included in the present study. They were divided into three groups according to the type and range of rib deformity. CS patients without any rib deformity were classified into the control group. The simple deformity group consisted of patients with localized fusion, bifurcation of2-3 ribs or increased or decreased 1 or 2 ribs. The complex deformity group was defined as patients with extensive fusion, bifurcation of ribs or combined with thechest wall defect. The radiographic parameters before surgery were recorded, including cobb angle, thoracic kyphosis, the number of vertebrae involved, the thoracic height(the vertical height between the center of T1 and T12), the thoracic transverse diameter(the horizontal distance between bilateral costal margins at the apex level). All of these patients were also evaluated by a standard test of pulmonary function, including vital capacity(VC), forced expiratory volume in the first second(FEV1), maximum ventilation volume(MVV), the percentage of these values to the predicted value and FEV1/FVC value. The difference of radiographic parameters and pulmonary function data in each group were analyzed. Mean while, the degree and pattern of pulmonary dysfunction were analyzed by using the chi-square test. Results: There was no difference of radiographic parameters among the three groups(P>0.05). The control group and simple deformity group had similar pulmonary function on the basis of different pulmonary parameters [VC:(81.88±11.11)% vs(78.22±8.49)%, P>0.05;FVC%:(81.66±9.72)% vs(78.35±6.74)%, P>0.05;FEV1:(79.50±10.18)% vs(75.73±8.44)%, P>0.05;MVV:(79.10 ±12.48)% vs(75.04±7.21)%, P>0.05]. The complex deformity group was proved to have worse pulmonary function compared with the control group [VC:(64.68 ±10.00)% vs(78.22±8.49)%, P=0.012;FVC:(64.61±10.57)% vs(78.35±6.74)%, P<0.001;FEV1:(59.57±10.16)%vs(75.73±8.44)%, P<0.001;MVV:(62.82±12.02)% vs(75.04±7.21)%, P=0.014]. The degree of pulmonary dysfunction in the control group and the simple deformity group was similar, mainly consisting of mild and moderate pulmonary dysfunction patients(χ^2=1.314, P=0.532). In the complex deformity group, moderate and severe pulmonary dysfunction was the most common(χ^2=40.1, P<0.001). The main type of pulmonary dysfunction in the three groups of CS patients was mixed pulmonary dysfunction(χ^2=6.4, P=0.202). Conclusions: In patients with moderate thoracic CS, the simple rib deformation has little effect on the pulmonary function. Compared to the control group, CS patients with complex rib deformity are more likely to compromise pulmonary dysfunction, a great majority of whom suffer from moderate or severe pulmonary dysfunction. And the pattern of pulmonary dysfunction is similar among the three groups.