CAJ | 학술논문

目的利用三维CT评价特发性脊柱侧凸患者脊柱后路内固定融合术后肺容积、肺高度、顶椎平面肺横截面积和凸侧/凹侧肺容积比的变化,探讨特发性脊柱侧凸患者矫形术后肺容积与肺功能之间的关系.方法自2009年4至2013年8月,共30例符合入选标准的患者纳入研究.男9例,女21例;年龄11.3～18.0岁,平均15.7岁.Lenke分型:Ⅰ型19例、Ⅱ型4例、Ⅲ型7例.Risser征:3级11例、4级7例、5级12例.所有患者均于术前和术后1周左右进行脊柱三维CT扫描,CT扫描时患者仰卧位并保持深吸气末期.将所有CT扫描的资料导入工作站,利用Syngo软件分别测量肺容积、肺高度和顶椎平面肺横截面积.结果特发性脊柱侧凸患者术前左侧肺高度为(21.4±2.6) cm,术后为(22.6±2.5) cm;右侧肺高度手术前为(21.9±2.1) cm,术后增加至(22.7±2.7) cm.术前的顶椎平面肺横截面积为(232.9±43.6) cm2,术后减小至(223.1±38.4) cm2.左侧肺容积、右侧肺容积、总肺容积以及凸侧/凹侧肺容积比的手术前后改变均无统计学意义.左肺高度、右肺高度和顶椎平面肺横截面积的改变与患者的性别、年龄、Lenke分型、Risser征、主胸弯的矫正率以及胸椎后凸的矫正率之间无明显的相关性.结论特发性脊柱侧凸患者后路内固定融合术后即刻发生了肺形态的变化,但术后即刻肺容积没有变化,仅表现为肺高度的增加.
목적 이용삼유CT평개특발성척주측철환자척주후로내고정융합술후폐용적、폐고도、정추평면폐횡절면적화철측/요측폐용적비적변화,탐토특발성척주측철환자교형술후폐용적여폐공능지간적관계.방법 자2009년4지2013년8월,공30례부합입선표준적환자납입연구.남9례,녀21례;년령11.3～18.0세,평균15.7세.Lenke분형:Ⅰ형19례、Ⅱ형4례、Ⅲ형7례.Risser정:3급11례、4급7례、5급12례.소유환자균우술전화술후1주좌우진행척주삼유CT소묘,CT소묘시환자앙와위병보지심흡기말기.장소유CT소묘적자료도입공작참,이용Syngo연건분별측량폐용적、폐고도화정추평면폐횡절면적.결과 특발성척주측철환자술전좌측폐고도위(21.4±2.6) cm,술후위(22.6±2.5) cm;우측폐고도수술전위(21.9±2.1) cm,술후증가지(22.7±2.7) cm.술전적정추평면폐횡절면적위(232.9±43.6) cm2,술후감소지(223.1±38.4) cm2.좌측폐용적、우측폐용적、총폐용적이급철측/요측폐용적비적수술전후개변균무통계학의의.좌폐고도、우폐고도화정추평면폐횡절면적적개변여환자적성별、년령、Lenke분형、Risser정、주흉만적교정솔이급흉추후철적교정솔지간무명현적상관성.결론 특발성척주측철환자후로내고정융합술후즉각발생료폐형태적변화,단술후즉각폐용적몰유변화,부표현위폐고도적증가.
Objective To evaluate the changes in the lung volume,lung height,convex to concave lung volume ratio and pulmonary cross-sectional area of apical vertebral plane after posterior spinal fusion and to further analyse the relation between postoperative lung volume and pulmonary function.Methods From April 2009 to August 2013,a total of 30 patients were involved in this study.There were 9 males and 21 females,whose age ranged from 11.3 to 18.0 years old,with an average age of 15.7 years.The Risser sign of the subjects were 11 Risser Ⅲ,7 Risser Ⅳ,12 Risser Ⅴ,while the Lenke's classification were 19 Lenke Ⅰ,4 Lenke Ⅱ and 7 Lenke m.All scans were obtained during deep inspiration breath-hold in supine position and performed both preoperatively and a week after operations.Then,we used Syngo software to manage the computed tomography scan imaging and to calculate the lung volume,the lung height and the pulmonary cross-sectional area of apical vertebral plane.Results Left lung height increased from (21.4±2.6) cm to (22.6±2.5) cm postoperatively.Right lung height was (21.9±2.1) cm while it increased to (22.7±2.7) cm postoperatively.The pulmonary cross-sectional area of apical vertebral plane decreased to (223.1 ±38.4) cm2 postoperatively.Left lung volume,right lung volume,total lung volume and convex to concave lung volume ratio showed no statistically significant difference.The changes in left and right lung height and the pulmonary cross-sectional area of apical vertebral plane showed no significant correlation with patients' sex,age,Lenke's classification,Risser sign,and the correction of predominant thoracic curve or kyphosis angle from T5 to T12.Conclusion The current study demonstrates the changes in lung morphology in AIS patients a week after posterior spinal fusion.It shows that lung height in AIS patients immediately increases postoperatively.However,the postoperative lung volume shows no statistical difference.