Early Changes in Pulmonary Function After Vertical Expandable Prosthetic Titanium Rib Insertion in Children With Thoracic Insufficiency Syndrome
Early Changes in Pulmonary Function After Vertical Expandable Prosthetic Titanium Rib Insertion in Children With Thoracic Insufficiency Syndrome
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DOI：
10.1097/bpo.0b013e3181929c8b
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发表时间：
2009-01-01
影响因子：
1.7
通讯作者：
Redding, Gregory
中科院分区：
文献类型：
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作者：
Mayer, Oscar Henry;Redding, Gregory
背景资料：在过去的十年中，垂直可扩张假体钛肋骨（VEPTR）已被插入患有胸廓功能不全综合征的儿童中，以扩张和支撑胸部，并允许进一步的肺生长。评价VEPTR插入后肺功能术后变化的已发表数据很少。我们假设VEPTR插入后肺功能会显著增加，并且插入越早，改善越大。方法：胸壁疾病研究组数据库，包含来自7个不同中心的VEPTR插入前后的数据，查询肺活量测定和肺容量测量，并分析数据以评估VEPTR放置对肺功能的短期影响。结果：用力肺活量、1秒用力呼气量占预测值的百分比在统计学上显著降低，残气量（RV）增加但未达到统计学显著性，首次术后访视时（7.7 +/- 4.8个月）总肺活量无变化。Cobb角明显减小。有任何肺功能和Cobb角年龄之间的绝对变化之间没有相关性在surgery.Conclusions：虽然有一个临床和影像学上明显的扩展后VEPTR插入胸部，有没有类似的改善肺容量，而是有一个强迫肺活量减少和增加残气量，其解释需要进一步研究。VEPTR插入后肺功能无变化表明，VEPTR插入的受益可能更多地体现在稳定胸腔和改善其他方式测量的呼吸力学方面。
Background: The vertical expandable prosthetic titanium rib (VEPTR) has been inserted in children with thoracic insufficiency syndrome for the last decade to expand and support the chest and allow for further lung growth. There are minimal published data evaluating the postoperative change in lung function after VEPTR insertion. We hypothesize that there will be a significant increase in lung function after VEPTR insertion, and the earlier the insertion, the greater the improvement.Methods: The Chest Wall Disorders Study Group Database, containing data before and after VEPTR insertion from 7 different centers, was queried for spirometry and lung Volume measurements, and the data were analyzed to assess the short-term effect on lung function of VEPTR placement.Results: There was a statistically significant decrease in forced vital capacity, forced expiratory volume in 1 second as a percent of predicted, an increase in residual volume (RV) that did not reach statistical significance, and there was no change in total lung capacity at the first postoperative visit (7.7 +/- 4.8 months). There was a significant decrease in Cobb angle. There was no correlation between absolute change in any pulmonary function and Cobb angle age at the time of surgery.Conclusions: Although there is a clinically and radiographically apparent expansion of the thorax after VEPTR insertion, there is no similar improvement in lung volume, and instead there is a decrease in forced vital capacity and increase in residual volume, the explanation for which requires further study. This lack of change in pulmonary function after VEPTR insertion suggests that the benefit of VEPTR insertion may be more in stabilizing the thorax and improving respiratory mechanics measured in other ways.