Abstract

Purpose

To investigate airway development and airway resistance by computed tomographic three-dimensional (3D) reconstruction of the bronchial tree in patients with adolescent idiopathic scoliosis (AIS). We evaluated factors predicting postoperative respiratory complications to provide timely treatment, prevent complications, and improve operative and anesthetic safety.

Methods

From August 2015 to August 2017, 53 AIS patients with a mean age of 15.4 years (range 10–20 years) were included in this study. Scoliotic parameters on radiographs were analyzed. Airway resistance was obtained by pulmonary function testing. All patients’ pulmonary bronchial trees were 3D-reconstructed via chest thin layer computed tomography to explore the correlation between the spinal–thoracic deformity parameters and airway resistance.

Results

Correlations between scoliotic parameters and airway development parameters were not statistically significant (P > 0.05). The scoliotic parameters such as Cobb angle, apical vertebral translation, rotation angle to sagittal plane, rotation angle to middle line, and apical vertebral body–rib ratio (AVB-R) were positively correlated with tracheal bifurcation angle (R²: 0.429, 0.374, 0.430, 0.504, and 0.414, respectively; P < 0.05). Cobb angle, rib hump, and apical vertebral body–rib ratio (AVB-R) were positively correlated with left principal bronchus length to right principal bronchus length (PBL-R) (R²: 0.373, 0.503, and 0.377, respectively; P < 0.05). Superficial area of bronchial tree (SABT) and narrow cross section of trachea (NCT) were negatively correlated with plethysmography Pre–Ref resistance ratio (Pre/Ref) (R²: − 0.365 and − 0.452, respectively; P < 0.05). SABT and NCT were negatively correlated with respiratory impedance (Zrs) (R²: − 0.327 and − 0.436, respectively; P < 0.05).

Conclusions

Pulmonary bronchial development in patients with AIS is affected by spinal–thoracic deformity. Comprehensive assessment of preoperative pulmonary function, especially airway resistance, is necessary in patients with AIS whether the thoracic scoliosis is severe or mild-to-moderate.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

中文翻译：

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基于计算机断层扫描的支气管树三维重建和气道阻力评估青少年特发性脊柱侧弯。

摘要

目的

通过计算机断层扫描三维 (3D) 重建青少年特发性脊柱侧弯 (AIS) 患者的支气管树来研究气道发育和气道阻力。我们评估了预测术后呼吸系统并发症的因素，以提供及时治疗、预防并发症并提高手术和麻醉安全性。

方法

2015 年 8 月至 2017 年 8 月，53 名平均年龄为 15.4 岁（范围 10-20 岁）的 AIS 患者被纳入本研究。分析了 X 光片上的脊柱侧弯参数。通过肺功能测试获得气道阻力。通过胸部薄层计算机断层扫描对所有患者的肺支气管树进行 3D 重建，以探索脊柱 - 胸部畸形参数与气道阻力之间的相关性。

结果

脊柱侧弯参数与气道发育参数之间的相关性无统计学意义（P  > 0.05）。Cobb角、顶椎平移、到矢状面的旋转角、到中线的旋转角、顶椎体-肋骨比（AVB-R）等脊柱侧凸参数与气管分叉角呈正相关（R ² : 0.429, 0.374 、0.430、0.504 和 0.414，分别；P  < 0.05)。Cobb 角、肋骨隆起和顶端椎体-肋骨比 (AVB-R) 与左主支气管长度与右主支气管长度 (PBL-R) 呈正相关（R ²分别为 0.373、0.503 和 0.377；P < 0.05)。支气管树表面积 (SABT) 和气管窄横截面 (NCT) 与体积描记术 Pre-Ref 电阻比 (Pre/Ref) 呈负相关（R ²分别为 - 0.365 和 - 0.452；P  < 0.05）。SABT 和 NCT 与呼吸阻抗 (Zrs) 呈负相关（R ²分别为 - 0.327 和 - 0.436；P  < 0.05）。

结论

AIS 患者的肺支气管发育受脊柱-胸廓畸形的影响。对于 AIS 患者，无论胸椎侧弯是重度还是轻中度，都需要全面评估术前肺功能，尤其是气道阻力。

图形摘要

这些幻灯片可以在电子补充材料下检索。