Pulmonary function after anterior double thoracotomy approach versus posterior surgery with costectomies in idiopathic thoracic scoliosis

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• 作者：Viola Bullmann (1)
  Tobias L. Schulte (2)
  Carolin Schmidt (2)
  Georg Gosheger (2)
  Nani Osada (3)
  Ulf R. Liljenqvist (4)
  
• 关键词：Idiopathic thoracic scoliosis ; Pulmonary function ; Anterior open surgery with double thoracotomy approach ; Posterior surgery with costectomy ; Pulmonary complication
• 刊名：European Spine Journal
• 出版年：2013
• 出版时间：March 2013
• 年：2013
• 卷：22
• 期：2/suppl
• 页码：164-171
• 全文大小：197KB
• 参考文献：1. Bullmann V, Halm HF, Niemeyer T, Hackenberg L, Liljenqvist U (2003) Dual-rod correction and instrumentation of idiopathic scoliosis with the Halm-Zielke instrumentation. Spine 28:1306-313
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  3. Gitelman Y, Lenke LG, Bridwell KH, Auerbach JD, Sides BA (2011) Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure: a 10-year follow-up analysis. Spine 36:1665-672 CrossRef
  4. Graham EJ, Lenke LG, Lowe TG, Betz RR, Bridwell KH, Kong Y, Blanke K (2000) Prospective pulmonary function evaluation following open thoracotomy for anterior spinal fusion in adolescent idiopathic scoliosis. Spine 25:2319-325 CrossRef
  5. Greggi T, Bakalouidis G, Fusaro I, Di Silvestre M, Lolli F, Martikos K, Vommaro F, Barbanti-Brodano G, Cioli A, Giacomini S (2010) Pulmonary function after thoracoplasty in surgical treatment of adolescent idiopathic scoliosis. J Spinal Disord Tech 23:e63–e69 CrossRef
  6. Izatt MT, Harvey JR, Adam CJ, Fender D, Labrom RD, Askin GN (2006) Recovery of pulmonary function following endoscopic anterior scoliosis correction: evaluation at 3, 6, 12, and 24 months after surgery. Spine 31:2469-477 CrossRef
  7. Kaneda K, Shono Y, Satoh S, Abumi K (1997) Anterior correction of thoracic scoliosis with Kaneda anterior spinal system. A preliminary report. Spine 22:1358-368 CrossRef
  8. Kim YJ, Lenke LG, Bridwell KH, Kim KL, Steger-May K (2005) Pulmonary function in adolescent idiopathic scoliosis relative to the surgical procedure. J Bone Joint Surg Am 87:1534-541 CrossRef
  9. Kim YJ, Lenke LG, Bridwell KH, Cheh G, Whorton J, Sides B (2007) Prospective pulmonary function comparison following posterior segmental spinal instrumentation and fusion of adolescent idiopathic scoliosis: is there a relationship between major thoracic curve correction and pulmonary function test improvement? Spine 32:2685-693 CrossRef
  10. Kim YJ, Lenke LG, Bridwell KH, Cheh G, Sides B, Whorton J (2008) Prospective pulmonary function comparison of anterior spinal fusion in adolescent idiopathic scoliosis: thoracotomy versus thoracoabdominal approach. Spine 33:1055-060 CrossRef
  11. Kishan S, Bastrom T, Betz RR, Lenke LG, Lowe TG, Clements D, D’Andrea L, Sucato DJ, Newton PO (2007) Thoracoscopic scoliosis surgery affects pulmonary function less than thoracotomy at 2 years postsurgery. Spine 32:453-58 CrossRef
  12. Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83:1169-181
  13. Lenke LG, Newton PO, Marks MC, Blanke KM, Sides B, Kim YJ, Bridwell KH (2004) Prospective pulmonary function comparison of open versus endoscopic anterior fusion combined with posterior fusion in adolescent idiopathic scoliosis. Spine 29:2055-060 CrossRef
  14. Liljenqvist UR, Bullmann V, Schulte TL, Hackenberg L, Halm HF (2006) Anterior dual rod instrumentation in idiopathic thoracic scoliosis. Eur Spine J 15:1118-127 CrossRef
  15. Lonner BS, Auerbach JD, Estreicher MB, Bert RR, Crawford AH, Lenke LG, Newton PO (2009) Pulmonary function changes after various anterior approaches in the treatment of adolescent idiopathic scoliosis. J Spinal Disord 22:551-58 CrossRef
  16. Lowe TG, Enguidanos ST, Smith DA, Hashim S, Eule JM, O’Brien MF, Diekmann MJ, Wilson L, Trommeter JM (2005) Single-rod versus dual-rod anterior instrumentation for idiopathic scoliosis: a biomechanical study. Spine 30:311-17 CrossRef
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• 作者单位：Viola Bullmann (1)
  Tobias L. Schulte (2)
  Carolin Schmidt (2)
  Georg Gosheger (2)
  Nani Osada (3)
  Ulf R. Liljenqvist (4)
  
  1. Department of Spinal Surgery, St. Franziskus Hospital, Sch?nsteinstrasse 63, 50825, Cologne, Germany
  2. Department of Orthopaedics and Tumor Orthopaedics, Münster University Hospital, Münster, Germany
  3. Department of Medical Informatics and Biomathematics, Münster University Hospital, Münster, Germany
  4. Department of Spinal Surgery, St. Franziskus Hospital, Münster, Germany
  
• ISSN：1432-0932

文摘

Introduction The surgical approach in the treatment of idiopathic thoracic scoliosis depends on the type of curve involved. In anterior correction, the rib hump is corrected by derotating the thoracic spine. In posterior scoliosis surgery, additional rib hump resection is sometimes necessary to achieve an optimal cosmetic result. The aim of this study was to compare pulmonary function in these two patient groups. Materials and methods Forty patients in the anterior group (A) were treated with standard double thoracotomy, with an anterior derotation spondylodesis and a primary stable dual-rod system. The posterior group (P) included 29 patients who were treated with a pedicle screw-based posterior instrumentation spondylodesis, with additional rib hump resection. Pulmonary function was evaluated preoperatively, on the 12th postoperative day, and at 3, 6, 12 and 24?months during the follow-up. Results The patients-mean age was 15?years in group A and 19 in group P with a standard deviation 8.7?years and a significant difference. With regard to body height or weight there were no significant differences between the two groups. In group A, the deterioration in pulmonary function immediately after the operation (from $ V_{{{\text{c}}_{\max } }} /{\text{FEV}}_{1} $ 75.3?%/71.3?% preoperatively to 38.5?%/36.1?% postoperatively) was clearer than in group P ( $ V_{{{\text{c}}_{\max } }} /{\text{FEV}}_{ 1} $ 71.6?%/65.7?% preoperatively to 47.7?%/48.4?% postoperatively). During a follow-up period of 3?months, the values improved in both groups in comparison with the values immediately after the operation. Up to the 2?year follow-up, pulmonary function in the posterior and anterior groups corresponded to the preoperative values, with no significant differences. There was a trend toward moderately increased values in the posterior group and moderately decreased values in the anterior group at the 2-year follow-up examination, in comparison with the preoperative baseline, but without a statistically significant difference. Two major complications occurred in the anterior group, with reintubation and several bronchoscopy examinations due to atelectasis. Conclusion The severe deterioration in group A is caused by the substantial trauma with double thoracotomy in contrast to rib hump resection. For patients with severe restrictive pulmonary distress, posterior instrumentation in combination with rib hump resection would be preferable to an anterior procedure involving double thoracotomy. Respiratory physiotherapy exercise should be administered in order to minimise postoperative pulmonary distress. In conclusion opening of the chest wall leads to deterioration of pulmonary function with improvement to the preoperative values after 6?months in the posterior and after 24?months in the anterior group.