CAJ | 학술논문

目的分析重度脊柱畸形的肺功能损害特征及其影响肺功能的相关影像学参数.方法 2009年9月至2014年12月,中山大学附属第一医院脊柱外科共66例符合入选标准的患者纳入研究.所有患者均行术前肺功能检查及站立位脊柱全长X线片,分析肺功能结果及其与脊柱影像学参数的相关性.结果 66例重度脊柱畸形患者中,57例(86.4％)合并有肺功能损害,其中54.6％为中重度肺功能损害[第1秒用力呼气容积(FEV1)≤59％],损害方式以限制性通气功能障碍为主.肺活量(VC)％、用力肺活量(FVC)％和FEV1％与主弯Cobb角、累及胸椎数目、累及椎体数目及局部后凸角呈显著负相关,而与顶椎位置呈显著正相关(顶椎越靠近头端,肺功能损害越严重).多元线性回归分析显示,主弯Cobb角和累及胸椎数目是肺通气功能降低的主要影响因素,解释肺容积下降的46.2％～ 55.1％.结论重度脊柱畸形多合并肺功能障碍,且以中重度限制性通气功能障碍为主.主弯Cobb角和受累胸椎数目是影响肺功能的主要因素.畸形越严重、节段越长、顶椎越靠头端的重度脊柱畸形患者,其肺功能损害越严重.
목적 분석중도척주기형적폐공능손해특정급기영향폐공능적상관영상학삼수.방법 2009년9월지2014년12월,중산대학부속제일의원척주외과공66례부합입선표준적환자납입연구.소유환자균행술전폐공능검사급참립위척주전장X선편,분석폐공능결과급기여척주영상학삼수적상관성.결과 66례중도척주기형환자중,57례(86.4％)합병유폐공능손해,기중54.6％위중중도폐공능손해[제1초용력호기용적(FEV1)≤59％],손해방식이한제성통기공능장애위주.폐활량(VC)％、용력폐활량(FVC)％화FEV1％여주만Cobb각、루급흉추수목、루급추체수목급국부후철각정현저부상관,이여정추위치정현저정상관(정추월고근두단,폐공능손해월엄중).다원선성회귀분석현시,주만Cobb각화루급흉추수목시폐통기공능강저적주요영향인소,해석폐용적하강적46.2％～ 55.1％.결론 중도척주기형다합병폐공능장애,차이중중도한제성통기공능장애위주.주만Cobb각화수루흉추수목시영향폐공능적주요인소.기형월엄중、절단월장、정추월고두단적중도척주기형환자,기폐공능손해월엄중.
Objective To investigate the pulmonary dysfunction patterns in severe spinal deformity and to identify radiological factors affecting the pulmonary function.Methods From September 2009 to December 2014,a total of 66 patients were involved in this Department of Spine Surgery,The First Affiliated Hospital,Sun Yat-sen University.Preoperative pulmonary function testing (PFTs) and radiographic examination were performed on all of the involved patients.Correlation analysis and subsequent stepwise multiple regression analysis were carried out to assess the associations between radiographic measurements of deformity and the results of pulmonary function testing.Results Fifty-seven out of 66 patients had impaired pulmonary dysfunction,and more than half of were ≤59％ predicted forced expiratory volume in 1 second (FEV1).Most of the patients with severe spinal deformity demonstrated a restrictive pattern of pulmonary function.The magnitude of the major curve,the number of involved thoracic vertebrae had significant effect on pulmonary function.While these 2 factors were associated with an increased risk of pulmonary impairment,they explained only 46.2％-55.1％ of the observed variability in vital capacity,forced vital capacity,and forced expiratory volume in one second.Conclusions Preoperative PFTs are clinically impaired in 86％ of patients with severe spinal deformity,and more than half of that were moderate and severe pulmonary dysfunction.The magnitude of the major curve and the number of involved thoracic vertebrae are the main risk factors influencing the pulmonary dysfunction.