早期脊柱融合对早发性脊柱侧凸患者肺功能及胸廓发育的影响

The effects of early spinal fusion on pulmonary function and thoracic development in patients with early-onset scoliosis

早发性脊柱侧凸(early-onset scoliosis,EOS)指10岁之前因任何原因发病的脊柱侧凸,如伴严重侧凸往往需要早期手术干预,但过早的脊柱融合又会对其胸廓及肺功能产生影响。依据发病原因,EOS可分为先天性、神经肌肉型、综合征相关型及特发性脊柱侧凸,治疗目标为控制侧凸进展的同时允许脊柱及胸廓尽可能地生长,以促进正常的肺泡及肺功能的发育,具体方式包括理疗、石膏及支具矫形、手术。由于患者年龄较小,处于胸廓及肺部发育的关键时期,且EOS的临床不一致性及复杂性,一些合并严重胸廓畸形的EOS还可能导致严重的心肺功能不全及相关并发症,威胁患儿的生命。但侧凸本身带来的胸廓解剖上的变化会限制胸壁运动、降低肺的顺应性,造成胸廓径线改变以及容积变小,导致限制性通气功能障碍。且脊柱融合术作为治疗EOS的主要干预手段,可矫正侧凸并控制进展,仍为一些严重的EOS主要外科选择。但过早的脊柱融合在限制胸廓高度及生长速度的同时甚至会导致肺组织受压变形、肺泡萎陷及发育异常,阻碍患儿的循环系统,导致呼吸功能障碍。其原因可能包括脊柱生长受限、曲轴现象以及肺泡增殖减少。针对早期脊柱融合对于EOS患者肺功能及胸廓发育的影响进行回顾和总结,并探讨其中可能存在的机制,以期更好地指导临床。

Early-onset scoliosis(EOS)is defined as the scoliosis occurs before 10 years old.Such patients with severe scoliosis often require early surgical intervention,but spinal fusion may also affect their thoracic development and lung function.Based on etiology,EOS can be classified as congenital,neuromuscular,syndrome-related and idiopathic scoliosis.The clinical goal is to control the progression of the curve while allowing the spine and chest to grow as much as possible to promote the development of alveolar.Clinical treatments include physiotherapy,plaster and brace correction as well as surgery.Patients of EOS were usually at the critical stage of thoracic and lung development due to their young age.In addition,the combination of severe thoracic deformity may also lead to life-threatening cardiopulmonary disorder and related complications considering the clinical inconsistency and complexity of EOS.Thoracic anatomical changes brought by scoliosis itself can limit chest wall movement and reduce lung compliance,resulting in changes in thorax diameter and compression of thoracic volume,leading to restrictive ventilation dysfunction.And spinal fusion can effectively correct curve and control progression,which still remains as the primary surgical option for severe EOS patients nowadays.However,early spinal fusion can also lead to deformation of lung tissue,collapse and malformation of alveolar while limiting the height and growth rate of thoracic cavity,hindering the circulatory system and leading to respiratory dysfunctionof children.Spinal growth restriction,crankshaft phenomenon and restricted alveolar proliferation may play a role in thisprocess.The present review retrospectively summarized the effects and possible mechanisms of early spinal fusion on lung function and thoracic development in patients with EOS,aiming to further provide guidance for clinical decisions.