肋椎关节损害对强直性脊柱炎胸腰椎后凸畸形患者肺功能的影响

The influence of the costovertebral joint involvement on pulmonary function in ankylosing spondylitis combined with thoracolumbar kyphosis

中文关键词:  强直性脊柱炎  胸腰椎后凸畸形  肺功能  肋椎关节损害

英文关键词:Ankylosing spondylitis  Thoracolumbar kyphosis  Pulmonary function tests  Costovertebral joint involvement

中文摘要:

  【摘要】 目的：分析强直性脊柱炎（ankylosing spondylitis，AS）胸腰椎后凸畸形患者肺功能损害的模式，探讨其肺功能与肋椎关节损害程度的相关性。方法：2004年4月~2011年12月采用截骨矫形术治疗45例AS胸腰椎后凸畸形患者，男41例，女4例，年龄22~60岁，平均34.6岁；病程3~37年，平均13.5年。后凸Cobb角55°~120°，平均83.5°。患者术前均行肺功能检测；根据患者术前CT评估其肋椎关节损害程度，并分为0、1、2、3、4共5级，对存在肺功能障碍伴肋椎关节损害的患者根据关节损害程度分组，1、2级为A组，3、4级为B组，对两组间肺功能参数进行比较；并对肋椎关节损害程度与术前Cobb角、年龄、病程和肺功能参数进行相关性分析。结果：7例肺功能正常；38例（84.4%）伴有不同程度的肺功能障碍，其中轻度13例，中度22例，重度3例；限制性通气功能障碍23例，阻塞性2例，混合性13例。41例（91.1%）患者出现不同程度的肋椎关节损害，其中1级7例，2级13例，3级18例，4级3例。B组患者肺活量（VC）、用力肺活量（FVC）及30倍第1秒用力肺活量（FEV1*30）等肺功能参数的实际值与预测值的百分比明显低于A组患者（P<0.05）。肋椎关节损害程度与后凸Cobb角呈正相关（r=0.43，P=0.024），而与患者年龄和病程无明显相关性（r=0.08，0.44，P>0.05）；VC、FVC及FEV1*30等参数的实际值与预测值的百分比均与肋椎关节损害程度有负相关性（r=-0.49，-0.35，-0.39，P<0.05）。结论：AS胸腰椎后凸畸形患者肺功能障碍较为常见，损害程度以中度通气功能障碍为主，损害类型以限制性通气功能障碍为主。肋椎关节损害是AS胸腰椎后凸畸形患者肺功能损害的一个影响因素。

英文摘要:

  【Abstract】 Objectives:　To investigate the pulmonary dysfunction patterns in ankylosing spondylitis(AS) patients with thoracolumbar kyphosis and to evaluate the association between pulmonary function and the severity of the costovertebral(CV) joints. Methods: A total of 45 patients underwent spinal osteotomy(41 males and 4 females) with a mean age of 34.6 years(range, 22-60 years) between April 2004 and December 2011 was included in this study. The average duration was 13.5 years(range, 3-37 years) and the average Cobb angle of thoracolumbar kyphosis was 83.5°(range, 55°-120°). Preoperative pulmonary function tests(PFTs) were performed in all patients. The severity of the CV joints was evaluated by CT scan and 5 different degrees(grade 0, 1, 2, 3, 4) were determined. According to the grades of the CV joints involvement, patients suffered form both pulmonary dysfunction and CV joints involvment were divided into two groups: group A(grade 1 or 2) and group B(grade 3 or 4). The parameters of PFTs were compared between two groups. The correlations between the severity of CV joint involvement and age, disease duration and parameters of PFTs were analyzed. Results: 7 patients had normal pulmonary function, while pulmonary dysfunction was observed in 38 patients(84.4%). Among these 38 patients, mild, moderate and severe dysfunction was observed in 13, 22 and 3 patients respectively. The number of patients with restrictive, obstructive and mixed ventilatory dysfunction was 23, 2 and 13 respectively. The CV joint involvement was noted in 41 patients(91.1%), and radiographic changes of grade 1, 2, 3 and 4 in CV joints were observed in 7, 13, 18 and 3 patients respectively. Patients in group B had significantly lower percentages of predicted vital capacity(VC%), forced vital capacity(FVC%) and 30 times forced expiratory volume in one second(FEV1*30%) than those in group A(P<0.05). There was positive correlation between the severity of the CV joint involvement and Cobb angle(r=0.43, P=0.024). Neither age nor disease duration showed a significant correlation with the severity of the CV joint involvement(r=0.08, 0.44, P>0.05). Nevertheless, the severity of radiographic changes of CV joints was negatively correlated with VC%, FVC% and FEV1*30%)(r=-0.49, -0.35, -0.39, P＜0.05). Conclusions: Pulmonary dysfunction is common in AS patients with thoracolumbar kyphosis. Majority of patients present moderate ventilatory impairment. Restrictive ventilatory impairment is the most prevalent pattern of pulmonary dysfunction. The involvement of the CV joints is an influencing factor of pulmonary dysfunction in AS patients with thoracolumbar kyphosis.