短节段肋骨切除胸廓成形对脊柱侧凸患者肺功能的影响

目的探讨特发性脊柱侧凸后路矫形凸侧短节段肋骨切除胸廓成形术对肺功能的影响。方法 2006年1月至2007年5月,19例特发性胸椎侧凸患者行后路三维矫形术,并经同一切口行凸侧短节段肋骨切除胸廓成形术。男9例,女10例,年龄11～20岁,平均14.5岁。Lenke分型：1型13例,2型6例;术前Cobb角60°～104°,平均73.9°;术中切除肋骨4～6根,平均5.4根,切除长度1.5～2cm。所有患者术前均进行肺功能检查,选择用力肺活量（forced vital capacity,FVC）、第1秒最大呼气量（forced expiratory volume in 1 second,FEV_1）及二者占预计值百分比（FVC%,FEV_1%）作为观察指标,并分别于术后3个月、6个月、1年、2年复查肺功能,了解肺功能变化情况。所得数据用统计学方法进行分析。结果本组病例术后Cobb角10°～59°,平均26.5°,侧凸矫正率为64.1%;术后3个月时,FVC、FEV_1、FVC%及FEV_1%较术前均有下降,但其差异无统计学意义,术后6个月时接近术前水平,术后1年及2年较术前均有升高。校正年龄和身高对肺功能的影响后,FVC%及FEV_1%的动态变化显示术后3个月至2年患者肺功能在持续改善。结论脊柱侧凸后路三维矫形结合凸侧短节段肋骨切除胸廓成形对患者的肺功能干扰小,术后肺功能恢复快,可作为脊柱侧凸合并中重度胸牢的治疗选择。

Pulmonary function after thoracoplasty with short segment ribs excision in the posterior surgical treatment of adolescent idiopathic scoliosis

Objective To evaluate the effect of thoracoplasty with short segment ribs excision on pulmonary function in the posterior surgical treatment of adolescent idiopathic scoliosis.Methods Between January 2006 and May 2007,19 patients with thoracic scoliosis underwent posterior fusion and thoracoplasty with short segment ribs excision.There were 9 males and 10 females,with an average age of 14.5 years（range,11 to 20 years）.There were 13 patients with Lenke type-1 curves and 6 patients with Lenke type-2 curves.The mean preoperative Cobb angle was 73.9°（range,60°- 104°）;the mean quantity of the resected ribs was 5.4（4 -6）;the length of the resected segment was 1.5-2 cm.All patients were evaluated for forced vital capacity（FVC） and forced expiratory volume in 1 second（FEV_1） before and after operation at 3,6,12,and 24 months.Results The mean postoperative Cobb angle is 26.5°（range,10°-59°） with a mean correction rate of 64.1%.FVC,FEV_1 and both of percent predicted values（FVC%and FEV_1%） were declined slightly at 3 months postoperatively compared with preoperative data,but they returned to the preoperative baseline at 6 months.At the 2-year follow up,the absolute value of all were better than the preoperative data.Conclusion Thoracoplasty with short segment ribs excision showed good rib hump correction,satisfactory clinical outcomes without pulmonary function compromise in the posterior surgical treatment of adolescent idiopathic scoliosis.