影响脊柱侧凸患者肺功能的脊柱胸廓畸形指标

摘要

目的 研究脊柱侧凸患者的肺功能及影响肺功能的脊柱胸廓畸形指标.方法 采用配对研究的方法,将78例先天性和特发性脊柱侧凸患者与正常受试者以性别和年龄1:1配对.测定两组受试者的肺功能和侧凸患者的脊柱胸廓畸形影像学指标.结果 脊柱侧凸患者第1秒用力呼气容积和用力肺活量成比例下降,肺总量和功能残气量降低,呈现以肺容积下降为特征的限制性通气功能障碍.弥散量相应降低,单位肺泡弥散量正常或略偏高.气道阻力和气道传导未受累.先天性脊柱侧凸患者除了上述改变外,还出现了气道阻力和残气量的异常.多元线性回归分析显示,受累胸椎数、胸腰椎高度、侧凸度数是肺容积降低的主要影响因素,解释肺容积下降的40%～51%.结论 脊柱侧凸患者的肺功能为限制性通气功能障碍伴弥散量降低.累及胸椎数越多、胸腰椎高度越低、侧凸度数越大,肺容积损害越明显.%Objective To investigate pulmonary function impairment and the spinal factors that may determine pulmonary function in patients with scoliosis. Methods Seventy-eight patients with idiopathic scoliosis or congenital scoliosis and 78 age- and gender-matched healthy subjects were enrolled in this study. The radiographic parameters of spinal deformity were obtained from patients with scoliosis. Both two groups received pulmonary function tests. Results Patients with scoliosis demonstrated a restrictive pattern of pulmonary function impairment with a proportional decrease in both forced expiratory volume in one second and forced vital capacity. Total lung capacity and functional residual capacity were reduced. Carbon monoxide diffusion capacity was decreased, while diffusion coefficient remained normal or slightly higher. Airway resistance and conductance were not affected. In addition, airway resistance and residual volume were found abnormal in patients with congenital scoliosis. Multiple linear regression analysis showed that three spinal factors including involved thoracic vertebrae, vertical height from C7 to S1, and Cobb angle were independently responsible for 40％ -51％ of total variances of forced vital capacity, forced expiratory volume in one second, total lung capacity, and functional residual capacity. Conclusions Patients with scoliosis have restrictive ventilation defects. More thoracic vertebrae involvement, lower vertical height, and larger Cobb angle are associated with severer impairment of lung volume.