摘要
目的：对伴有呼吸功能障碍的严重僵硬脊柱畸形（不包含半椎体畸形）患者行经后路全脊椎切除（posteriorvertebralcolumnresection，PVCR）脊柱矫形，对术前、术后肺功能检查（pulmonaryfunctiontest， PFT）的资料进行分析，总结其变化规律。方法将2004年1月至2009年1月，我院收治的除半椎体畸形外的严重僵硬脊柱畸形患者中伴有肺功能障碍的24例纳入本研究。男11例，女13例，年龄11～45岁，平均（18.9±8.0）岁；术前侧凸Cobb’s角平均（110.1±14.6）°（94～170）°，后凸Cobb’s角平均（80.6±29.2）°（42～160）°。所有患者均行PVCR术，以术前肺功能肺活量（vitalcapacity，VC）分为中度呼吸功能障碍组（40%～60%）和重度呼吸功能障碍组（低于40%）。术前、术后2周、3个月、6个月、1年、2年行肺功能检查，评估患者的肺功能状况，分析肺功能各参数（肺活量－VC，VC实测值与预计值的百分比－VC%，用力肺活量－FVC，FVC实测值与预计值的百分比－FVC%，第一秒用力呼气量－FEV1，FEV1实测值与预计值的百分比－FEV1％）与术后恢复时间的关系，患者术前、术后自觉症状改善（呼吸窘迫、肺部感染、体力、生活质量）与术后恢复时间的关系。结果终末随访24个月。术后2周，肺功能参数FVC、FVC%、FEV1、FEV1%，重度呼吸功能障碍组分别为：（0.92±0.04）L、（26.55±0.67）%、（0.98±0.06）L、（25.48±0.41）%，明显低于术前（1.13±0.06）L、（28.27±0.55）%、（1.04±0.06）L、（27.42±0.36）%（P＜0.05），中度呼吸功能障碍组分别为：（1.28±0.06）L、（38.83±1.00）%、（1.05±0.03）L、（35.43±0.36）%，明显低于术前（1.42±0.04）L、（40.33±0.79）%、（1.33±0.04）L、（37.38±0.47）%（P＜0.05），动脉血气分析均提示异常，肺功能水平明显低于术前，差异均有统计学意义（P＜0.05）；术后3个月，患者的肺功能参数开始逐渐恢复，但仍不及术前水平；术后1年，患者肺功能水平略高于术前，各参数与术前比较，差异均无统计学意义（P＞0.05），但96%的患者自觉症状得到改善，MET评分较术前高，动脉血气分析及肺部胸片未见异常；术后2年，肺功能参数FVC、FVC%、FEV1、FEV1%，重度呼吸功能障碍组分别为：（1.48±0.03）L、（33.67±0.49）%、（1.28±0.03）L、（31.53±0.41）%，中度呼吸功能障碍组分别为：（1.56±0.06）L、（42.05±0.38）%、（1.43±0.04）L、（39.32±0.40）%，所有患者的肺功能明显高于术前的基础水平（VC恢复17.1％， FVC恢复18.7%，FEV1恢复14.4%），差异有统计学意义（P＜0.05），所有患者自觉症状得到改善，动脉血气分析正常，胸片未见肺异常。术后肺功能参数变化率、自觉症状改善率均与恢复时间成正相关。结论严重僵硬脊柱畸形患者行PVCR术后，肺功能在2周内明显下降，随着恢复时间的延长，术后1年肺功能逐渐恢复到术前基础水平，术后2年较术前有明显改善，特别是术前表现为重度呼吸功能障碍的患者。PVCR术后2年患者PFT较术前有改善，多数患者术后1年自觉症状改善，并且动脉血气分析正常，胸部X线片未见肺异常，术后2年24例自觉症状均明显改善，这对提高患者生活质量至关重要。
Objective To analyze the preoperative and postoperative pulmonary function test （ PFT ） results in the patients with severe rigid spinal deformity （ excluding hemivertebra deformity ） accompanied by respiratory dysfunction who underwent posterior vertebral column resection （ PVCR ） and to summarize the variation rules.Methods From January 2004 to January 2009, 24 patients with severe rigid spinal deformity （ excluding hemivertebra deformity ） and obvious respiratory dysfunction were enrolled. Their mean age was （ 18.9±8.0 ） years old （ range：11-45 years ）. The average preoperative scoliotic Cobb’s angle was （ 110.1±14.6 ） ° （ range：94°-170° ） and the average preoperative kyphotic Cobb’s angle was （ 80.6±29.2 ） ° （ range：42°-160° ）. All the patients underwent PVCR. They were divided into moderate （ 40%-60%） impairment group and severe （0.05 ）. However, subjective symptom improvement was noticed in 96%of the patients. The Metabolic Equivalent of Energy （ MET ） grade was improved after the operation, and the ABG analysis and chest X-ray showed no abnormality. The FVC, FVC%, FEV1 and FEV1%were （ 1.48±0.03 ） L, （ 33.67±0.49 ）%, （ 1.28±0.03 ） L and （ 31.53±0.41 ）%in severe impairment group and （ 1.56±0.06 ） L, （ 42.05±0.38 ）%, （ 1.43±0.04 ） L and （ 39.32±0.40 ）%in moderate impairment group at 2 years after the operation. The pulmonary function was obviously improved in all the patients. The VC was recovered by 17.1%, FVC by 18.7%and FEV1 by 14.4%, and the differences between them were statistically signiifcant （ P〈0.05 ）. Subjective symptom improvement was noticed in all the patients, and the ABG analysis and chest X-ray showed no abnormality. There was a positive correlation between the recovery time and rate of change of the postoperative PFT parameters and improvement rate of the subjective symptoms. Conclusions The pulmonary function in the patients with severe rigid spinal deformity becomes worse at 2 weeks after PVCR. With the extension of recovery time, it will return to preoperative baseline at 1 year after the operation and be signiifcantly improved at 2 years after the operation, especially in the patients with severe ventilatory disorders. The PFT parameters at 2 years after PVCR are higher than the preoperative parameters. What is more, subjective symptom improvement is noticed in most patients at 1 year after the operation and the ABG analysis and chest X-ray show no abnormality. Signiifcant subjective symptom improvement is noticed in almost all the patients at 2 years after the operation, which is crucial for the improvement of the quality of life.
出处
《中国骨与关节杂志》
CAS
2014年第12期901-905,共5页
Chinese Journal of Bone and Joint
关键词
脊柱后凸
脊柱侧凸
脊柱弯曲
呼吸障碍
经后路全脊椎切除
Kyphosis Scoliosis Spinal curvature Respiration disorder Posterior vertebral column resection（PVCR）
