Scott Yang, Apeksha Gupta, Michael E Trask, Natalie M Maharaj, Anna V Faino, Sean Pirkle, Kelson Roy Adcock, Jennifer M Bauer, Burt Yaszay, Gregory Redding
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Predicted marginal means of PFT measures were calculated, and Bonferroni adjusted p-values were reported. Spearman correlation was used to analyze the relationship between radiographic measures and PFTs.</p><p><strong>Results: </strong>Fifty-one patients with EOS were included (mean age 7.2 years at index surgery). The index distraction-based growth-friendly construct was 31 (60.8%) vertical expandable prosthetic titanium rib implants, 9 (17.6%) traditional growing rods, and 11 (21.6%) magnetically controlled growing rods; 23 patients (45%) underwent final fusion. The median duration from the first to the most recent PFT was 44 months. The random-effects model showed no significant change in FVC, FVC%, and FEV1 over time since surgery. When changes in PFTs were analyzed by scoliosis etiology, there was no significant change in PFT measures after surgical treatment with any etiology except in congenital scoliosis where both FVC% and FEV1% significantly decreased during growth-friendly treatment and fusion compared with before surgery. T1-T12 length significantly correlated moderately with FVC (rho = 0.46, p < 0.0001), but not FVC%. Major curve Cobb angle did not significantly correlate with PFT measures.</p><p><strong>Conclusions: </strong>Growth-friendly EOS surgery did not improve pulmonary function, but at best prevented further pulmonary decline, except in children with congenital scoliosis who had worsening function over time.</p><p><strong>Level of evidence: </strong>Prognostic Level III. 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This study aims to evaluate change in serial pulmonary function in children with EOS after surgery.</p><p><strong>Methods: </strong>A retrospective review was performed at a single academic hospital. All patients who had surgical treatment of EOS and repeated pulmonary function test (PFT) data were included. Pulmonary function test (PFT) measures included forced vital capacity (FVC), FVC % of predicted norms (FVC%), forced expiratory volume in 1 second (FEV1), and FEV1% of predicted norms (FEV1%). To determine whether PFT changed postsurgery, a random-effects mixed model was used. Predicted marginal means of PFT measures were calculated, and Bonferroni adjusted p-values were reported. Spearman correlation was used to analyze the relationship between radiographic measures and PFTs.</p><p><strong>Results: </strong>Fifty-one patients with EOS were included (mean age 7.2 years at index surgery). The index distraction-based growth-friendly construct was 31 (60.8%) vertical expandable prosthetic titanium rib implants, 9 (17.6%) traditional growing rods, and 11 (21.6%) magnetically controlled growing rods; 23 patients (45%) underwent final fusion. The median duration from the first to the most recent PFT was 44 months. The random-effects model showed no significant change in FVC, FVC%, and FEV1 over time since surgery. When changes in PFTs were analyzed by scoliosis etiology, there was no significant change in PFT measures after surgical treatment with any etiology except in congenital scoliosis where both FVC% and FEV1% significantly decreased during growth-friendly treatment and fusion compared with before surgery. T1-T12 length significantly correlated moderately with FVC (rho = 0.46, p < 0.0001), but not FVC%. 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引用次数: 0
摘要
背景:早发性脊柱侧凸(EOS)手术治疗后的纵向肺预后尚未得到很好的报道。本研究旨在评估EOS患儿术后连续肺功能的变化。方法:在一家学术医院进行回顾性研究。所有接受手术治疗的EOS患者和重复肺功能测试(PFT)数据均被纳入研究。肺功能试验(PFT)指标包括用力肺活量(FVC)、用力肺活量占预测标准值的百分比(FVC%)、用力呼气量1秒内(FEV1)和用力呼气量占预测标准值的1% (FEV1%)。为了确定术后PFT是否改变,采用随机效应混合模型。计算PFT测量的预测边际均值,并报告经Bonferroni调整的p值。采用Spearman相关分析影像学指标与PFTs之间的关系。结果:纳入51例EOS患者(指数手术时平均年龄7.2岁)。基于牵张的生长友好型构建指标为垂直可伸缩钛肋骨植入物31个(60.8%),传统生长棒9个(17.6%),磁控生长棒11个(21.6%);23例患者(45%)接受了最终融合。从第一次到最近一次PFT的中位持续时间为44个月。随机效应模型显示手术后FVC、FVC%和FEV1随时间无显著变化。当通过脊柱侧凸病因分析PFTs的变化时,除先天性脊柱侧凸在生长友好治疗和融合期间FVC%和FEV1%与术前相比显著降低外,任何病因的手术治疗后PFT测量均无显著变化。T1-T12长度与FVC呈正相关(rho = 0.46, p < 0.0001),但与FVC%无关。主曲线Cobb角与PFT测量无显著相关。结论:生长友好型EOS手术不能改善肺功能,但最好能防止肺功能进一步衰退,除了先天性脊柱侧凸患儿,他们的功能随着时间的推移而恶化。证据等级:预后III级。有关证据水平的完整描述,请参见作者说明。
Longitudinal Pulmonary Function After Surgical Treatment of Early-Onset Scoliosis.
Background: Longitudinal pulmonary outcomes after surgical treatment of early-onset scoliosis (EOS) are not well reported. This study aims to evaluate change in serial pulmonary function in children with EOS after surgery.
Methods: A retrospective review was performed at a single academic hospital. All patients who had surgical treatment of EOS and repeated pulmonary function test (PFT) data were included. Pulmonary function test (PFT) measures included forced vital capacity (FVC), FVC % of predicted norms (FVC%), forced expiratory volume in 1 second (FEV1), and FEV1% of predicted norms (FEV1%). To determine whether PFT changed postsurgery, a random-effects mixed model was used. Predicted marginal means of PFT measures were calculated, and Bonferroni adjusted p-values were reported. Spearman correlation was used to analyze the relationship between radiographic measures and PFTs.
Results: Fifty-one patients with EOS were included (mean age 7.2 years at index surgery). The index distraction-based growth-friendly construct was 31 (60.8%) vertical expandable prosthetic titanium rib implants, 9 (17.6%) traditional growing rods, and 11 (21.6%) magnetically controlled growing rods; 23 patients (45%) underwent final fusion. The median duration from the first to the most recent PFT was 44 months. The random-effects model showed no significant change in FVC, FVC%, and FEV1 over time since surgery. When changes in PFTs were analyzed by scoliosis etiology, there was no significant change in PFT measures after surgical treatment with any etiology except in congenital scoliosis where both FVC% and FEV1% significantly decreased during growth-friendly treatment and fusion compared with before surgery. T1-T12 length significantly correlated moderately with FVC (rho = 0.46, p < 0.0001), but not FVC%. Major curve Cobb angle did not significantly correlate with PFT measures.
Conclusions: Growth-friendly EOS surgery did not improve pulmonary function, but at best prevented further pulmonary decline, except in children with congenital scoliosis who had worsening function over time.
Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.