STUDY DESIGN:Lung volumes and thoracic anatomy were measured from low-dose computed tomography (CT) scans preoperatively and 2 years following thoracoscopic anterior spinal fusion (TASF) for adolescent idiopathic scoliosis (AIS). OBJECTIVE:The aim of this study was to assess changes in lung volume after TASF surgical correction. SUMMARY OF BACKGROUND DATA:AIS patients are known to have decreased pulmonary function as a consequence of their spinal and ribcage deformity. Several studies have evaluated changes in pulmonary function clinically after scoliosis correction surgery showing varied results. To date, there have been no published studies using CT to evaluate lung volume changes following TASF. METHODS:Twenty-three female AIS patients with both pre- and 2 years postoperative low-dose CT scans were selected from an ethically approved, historical databank. Three-dimensional lung volumes were reconstructed to determine anatomical lung volumes. Right and left lung volumes, total lung volume, and right-to-left lung volume ratio were obtained as well as hemithoracic symmetry, to indicate the extent of thorax deformity. Cobb angle, rib hump, levels fused in surgery, and patient height were used for correlation analysis with the lung volume results. RESULTS:Left lung volume, total lung volume, and hemithoracic ratio all increased significantly 2 years after surgery. There was no significant change in right-to-left lung volume ratio (P = 0.36). Statistical regression found significant positive correlation between lung volume changes, reduction in Cobb angle, increase in height, and improvement in hemithoracic symmetry ratio. CONCLUSION:TASF resulted in a statistically significant increase in lung volume following surgery, as well as improvement in the symmetry of the thoracic architecture; however, the postoperative lung volumes remained in the lower 50th percentile relative to females without thoracic deformity. Furthermore, change in lung volume was significantly correlated with changes in Cobb angle, hemithoracic asymmetry, and increased patient height, which are important consequences of thoracic deformity correction surgery. LEVEL OF EVIDENCE:3.

译文

研究设计:在术前和胸腔镜前路脊柱融合术(TASF)治疗后的青少年特发性脊柱侧凸(AIS)进行低剂量计算机断层扫描(CT)扫描时,测量肺体积和胸部解剖结构。
目的:本研究旨在评估TASF手术矫正后肺容量的变化。
背景数据摘要:已知由于脊柱和胸腔畸形,AIS患者的肺功能下降。多项研究评估了脊柱侧弯矫正手术后临床上肺功能的变化,结果各不相同。迄今为止,还没有发表使用CT评估TASF后肺容量变化的研究。
方法:从符合道德标准的历史数据库中选择了23例术前和术后2年均进行低剂量CT扫描的女性AIS患者。重建三维肺体积以确定解剖肺体积。获得左右肺体积,总肺体积和左右肺体积比以及半胸对称性,以指示胸廓畸形的程度。将Cobb角,肋骨隆起,手术中的融合水平以及患者身高用于与肺容量结果的相关性分析。
结果:术后2年,左肺容积,总肺容积和半胸腔比率均显着增加。左右肺体积比无明显变化(P = 0.36)。统计回归发现,肺体积变化,Cobb角减小,身高增加和半胸对称性比率改善之间存在显着正相关。
结论:TASF导致手术后肺体积显着增加,并改善了胸腔结构的对称性。但是,相对于没有胸椎畸形的女性,术后肺活量仍处于较低的50%。此外,肺容量的变化与Cobb角的变化,半胸廓不对称以及患者身高的增加显着相关,这是胸廓畸形矫正手术的重要结果。
证据级别:3。

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