目的:一些青少年特发性脊柱侧凸(AIS)患者肺功能受损。然而,关于这些患者的肺损伤与各种脊柱畸形参数之间关系的证据尚不清楚,影响临床管理。本系统综述和荟萃分析旨在总结患有AIS的青少年的各种肺功能参数与影像学特征之间的关联。
方法:搜索PubMed,Embase,PEDro,SPORTDiscus,CINAHL,科克伦图书馆,和PsycINFO(从开始到2022年3月14日)没有语言限制。选择了报告AIS患者肺功能与脊柱畸形之间关联的原始研究。独立审稿人根据系统评价和荟萃分析指南的首选报告项目提取数据并评估纳入研究的方法学质量。使用随机效应荟萃分析计算Pearson相关性和95%置信区间。
结果:纳入27项研究,涉及3162名参与者。有限的质量证据支持几个脊柱参数与肺功能参数显着相关(例如,预测用力肺活量的绝对值和百分比(FVC;%FVC),1秒用力呼气量(FEV1;%FEV1),AIS患者的总肺活量(TLC;%TLC)。具体来说,荟萃分析表明,冠状面主胸廓Cobb角与FVC呈显著负相关(r=-0.245),%FVC(r=-0.302),FEV1(r=-0.232),%FEV1(r=-0.348),FEV1/FVC比值(r=-0.166),TLC(r=-0.302),%TLC(r=-0.183),和预测肺活量百分比(r=-0.272)(p<0.001)。同样,胸椎顶椎旋转与%FVC(r=-0.215)和%TLC(r=-0.126)呈负相关(p<0.05)。相反,胸椎后凸角度与%FVC(r=0.180)和%FEV1(r=0.193)呈正相关(p<0.05)。
结论:胸廓Cobb角较大,较大的根尖椎骨旋转角度,或低钾后凸与AIS患者更大的肺损伤显着相关,尽管证据有限。从临床的角度来看,结果强调了在这些患者中减少三维脊柱畸形对保持肺功能的重要性.需要更多的研究来证实这些结果。
Some teenagers with adolescent idiopathic scoliosis (AIS) display compromised lung function. However, the evidence regarding the relations between pulmonary impairments and various spinal deformity parameters in these patients remains unclear, which affects clinical management. This systematic review and meta-analysis aimed to summarize the associations between various lung function parameters and radiographic features in teenagers with AIS.
A search of PubMed, Embase, PEDro, SPORTDiscus, CINAHL, Cochrane Library, and PsycINFO (from inception to March 14, 2022) without language restriction. Original studies reporting the associations between lung function and spinal deformity in patients with AIS were selected. Independent reviewers extracted data and evaluated the methodological quality of the included studies according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pearson correlation and 95% confidence intervals were calculated using random-effects meta-analysis.
Twenty-seven studies involving 3162 participants were included. Limited-quality evidence supported that several spinal parameters were significantly related to lung function parameters (e.g., absolute value and percent of the predicted forced vital capacity (FVC; %FVC), forced expiratory volume in one second (FEV1; %FEV1), and total lung capacity (TLC; %TLC)) in AIS patients. Specifically, meta-analyses showed that main thoracic Cobb angles in the coronal plane were significantly and negatively related to FVC (r = - 0.245), %FVC (r = - 0.302), FEV1 (r = - 0.232), %FEV1 (r = - 0.348), FEV1/FVC ratio (r = - 0.166), TLC (r = - 0.302), %TLC (r = - 0.183), and percent predicted vital capacity (r = - 0.272) (p < 0.001). Similarly, thoracic apical vertebral rotation was negatively associated with %FVC (r = - 0.215) and %TLC (r = - 0.126) (p < 0.05). Conversely, thoracic kyphosis angles were positively related to %FVC (r = 0.180) and %FEV1 (r = 0.193) (p < 0.05).
Larger thoracic Cobb angles, greater apical vertebral rotation angle, or hypokyphosis were significantly associated with greater pulmonary impairments in patients with AIS, although the evidence was limited. From a clinical perspective, the results highlight the importance of minimizing the three-dimensional spinal deformity in preserving lung function in these patients. More research is warranted to confirm these results.