Evaluation On Changes And Significance Of Pulmonary Function In Patients With Adolescent Idiopathic Scoliosis Relative To The Surgical Approach Used For Spinal Arthrodesis

Objective To evaluate prospectively, at regular intervals, the changes and the significance in pulmonary function after surgical arthrodesis of adolescent idiopathic scoliosis in a homogeneous population within 2 years relative to the surgical approach used for spinal arthrodesis.Method Since October 2003 to March 2006 , there were 85 patients of Scoliosis operated in our department ,67 Adolescent Idiopathic Scoliosis patients , chosen from 85 patients of Scoliosis, had structive thoracic and thoracic-lumbal types of adolescent idiopathic scoliosis were evaluated in the investigation, 67 patients were endivided into 3 groups depending on the surgical approach used for spinal fusion:Group 1 (n = 19) underwent a posterior spinal fusion with allogeneic bone graft; Group 2 (n = 28) underwent a posterior spinal fusion with rib resection thoracoplasty; and Group 3 (n = 20) underwent a combined anterior and posterior spinal fusion with autogenous rib graft used , respectively.All patients undergoing surgical treatment at the authors' institution were prospectively evaluated with pulmonary function tests assessing volume (forced vital capacity FCV) and flow (forced expiratory volume in 1 second FEV1). Pulmonary functions were evaluated before surgery and after surgery at 3 months, 1 year, 2 years. Results 1)A11 groups of patients showed a significantly difference of pulmonary function contrasting 3 monthes after operation with preoperation (P < 0.05),which meaned various degree of decline. Two years after surgery,Group 1 had significantly improved pulmonary function values (P < 0.05), whereas the pulmonary function values of patients in Groups 2 and 3 had returned nearly to preoperative values(P > 0.05) . there existed negative correlation between cobb angle,kyphos angle and preoperative pulmonary function values.Conclusion 1) Patients which underwent a posterior spinal fusion with allogeneic bone graft showed a decline in pulmonary function at 3 months after surgery,their pulmonary function values at 2 years after surgery had shown an greater improvement than their values at preopration. 2) Patients ,which underwent a posterior spinal fusion with rib resection thoracoplasty or combined anterior and posterior spinal fusion with autogenous rib graft used , showed a decline in pulmonary function at 3 months after surgery also,but postoperative pulmonary function tests only returned to preoperative values at 2 years after surgery. 3) There existed negative correlation between cobb angle,kyphos angle and preoperative pulmonary function values.