两种后路矫形术对脊柱侧后凸患者肺功能影响的观察

目的观察经后路全脊椎切除联合椎弓根钉棒矫形与单纯钉棒系统矫形两种术式,治疗伴有显著通气功能障碍的脊柱侧后凸患者术后的肺功能变化情况。方法回顾性分析2004-06-2008-01行后路手术治疗16例伴有中、重度通气功能障碍的侧后凸畸形患者。术前以用力肺活量（FVC）与FEV1值评价通气功能损害。依据畸形严重程度及僵硬度,选择经后路全脊椎切除并椎弓根钉棒矫形术或单纯椎弓根钉棒矫形,术后复查肺功能,定期随访。结果全脊椎切除组侧凸及后凸矫正率分别达到68.5%和76.7%,单纯钉棒矫形侧凸及后凸矫正率分别为53.1%和48.0%,术后6个月患者肺功能参数较术前均有提高,且全脊椎切除组矫形率及通气改善均优于单纯后路钉棒矫形组。全脊椎切除组并发症发生率较高。结论后路矫形有助于严重侧后凸患者早期改善其肺通气功能,经后路全脊椎切除术能获得良好的矫形和肺功能改善。

Obseration of the influence due to different posterior operative procedure on pulmonary function of scoliokyphosis complicated in striking restrictive ventilatory defect

Objective To compare and analyze the change trends of pulmonary function in scoliokyphosis complicated with striking restrictive ventilatory defect after posterior vertebral column resection（PVCR）combined pedicle instrumentation and posterior pedicle instrumentation alone.Methods Scoliokyphosis（16 cases）with moderate or severe restrictive ventilatory defect which underwent operative treatment from June 2004 to January 2008 were reviewed.Pulmonary volume and flow were evaluated by the forced vital capacity（FVC）and the forced expiratory volume in 1 second（FEV1）.Based on flexibility and severity of the curves,posterior vertebral column resection combined pedicle instrumentation,or single posterior pedicle instrumentation have been chosen in deformity correction.Follow-up was conducted.Results The deformity correction rate averaged 68.5% in the sagittal plane and 76.7% in the coronal plane after PVCR,and were 53.1% and 48.0% after pedicle instrumentation alone,respectively.Patients performed PVCR showed significant improvement of curve on coronal and sagittal plane correction and the pulmonary function at 6 months postoperative,than other patients.In addition,there were more postoperative complication of PVCR include in pull-out delay,pulmonary edema and pulmonary infection.Conclusion PVCR is effective and suitable in correct rigid and severe scoliokyphosis with moderate or severe restrictive ventilatory defect.The pulmonary function would be influenced by posterior approach of deformity correction during a short postoperative term,but it could be restore and increased.