Purpose

Thoracoplasty is a procedure which involves rib resection from the costovertebral junction to the apex of the rib hump deformity to address the cosmetic concerns of patients of scoliosis. There is conflicting literature on its effect on pulmonary function. The present meta-analysis was conducted to review and analyze the available literature and ascertain the effect of thoracoplasty on pulmonary function.

Methods

Search was conducted according to PRISMA guidelines on three databases. After analysis of all the search results by title, abstracts and full texts—10 studies were identified for inclusion in the review. We included studies which had analyzed preoperative and postoperative pulmonary function tests (PFTs) after thoracoplasty. Pooled estimates were calculated for pulmonary function, and effect of other factors was analyzed by subgroup analysis and meta-regression.

Results

The included studies were published between 1998 and 2019. A total of 385 patients were included in these studies, with a mean age of 15.01 years, with a female preponderance. Apprehension over appearance of rib hump was the most common indication for thoracoplasty. Percent-predicted forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV-1) were significantly decreased on follow-up. Anterior approach to corrective surgery and lower age were found to be associated with worse pulmonary function. Preoperative Cobb’s angle was found to have significant impact on decrease in FEV-1 only, but not on other PFT parameters.

Conclusion

Overall decrease in pulmonary function after thoracoplasty necessitates the need of adequate preoperative pulmonary function to mitigate its effect on patient well-being. Use of a posterior approach for corrective surgery when thoracoplasty is planned might lead to better outcomes. More research is needed to study effect of preoperative Cobb’s angle on pulmonary function.

中文翻译：

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青少年特发性脊柱侧弯胸廓成形术后的肺功能：系统评价和荟萃分析

目的

胸廓成形术是一种手术，涉及从肋椎交界处到肋骨隆起畸形顶点的肋骨切除术，以解决脊柱侧凸患者的美容问题。关于其对肺功能的影响存在相互矛盾的文献。本荟萃分析旨在回顾和分析现有文献，并确定胸廓成形术对肺功能的影响。

方法

搜索是根据 PRISMA 指南对三个数据库进行的。在按标题、摘要和全文分析所有搜索结果后，确定了 10 项研究纳入审查。我们纳入了分析胸廓成形术后术前和术后肺功能测试 (PFT) 的研究。计算肺功能的汇总估计值，并通过亚组分析和荟萃回归分析其他因素的影响。

结果

纳入的研究发表于 1998 年至 2019 年间。这些研究共纳入 385 名患者，平均年龄为 15.01 岁，女性占多数。对肋骨隆起外观的担忧是胸廓成形术最常见的指征。随访中预测的用力肺活量百分比 (FVC) 和 1 秒用力呼气量 (FEV-1) 显着下降。发现前路矫正手术和较低年龄与较差的肺功能有关。发现术前 Cobb 角仅对 FEV-1 的降低有显着影响，但对其他 PFT 参数没有影响。

结论

胸廓成形术后肺功能的总体下降需要充分的术前肺功能以减轻其对患者健康的影响。当计划进行胸廓成形术时，使用后路手术进行矫正手术可能会带来更好的结果。需要更多的研究来研究术前Cobb角对肺功能的影响。