Perioperative respiratory care in severe scoliosis patients / 现代临床护理

Objective To investigate perioperative nursing of respiratory system in severe scoliosis patients.Methods 26 severe scoliosis patients with respiratory function training before operation were retrospected.All of them tested pulmonary function before and after training,postoperative respiratory system nursing were also taken to maintain airway unobstructed,including respiratory rate and oxygen saturation monitoring,effective pain management and respiratory complications controlling.Results The average forced vital capacity(FVC)was 45.9%and 52.1%before and after breathing exercises,the mean forced expiratory volume in one second(FEV1)was 43.8%and 48.8%before and after breathing exercises,with lung function improvement in 69.2%patients. There were two hemopneumothorax and three mild or moderate pleural effusion occurred within 10 days after surgery,but all recovered after effective treatment and nursing.Conclusions Perioperative systematic and effective training in respiratory function and airway management can improve lung function and surgical safety,reduce the incidence of postoperative pulmonary complications,and promote early rehabilitation .

Halo pelvic distraction in combination with total spine osteotomy and internal fixation for treatment of severe scoliosis / 中国矫形外科杂志

[Objective]To report the records of 185 patients in whom severe scoliosis had been treated with preoperative halo-pelvic distraction and following total spine osteotomy and internal fixation.[Method]Preoperative halo-pelvic distraction was applied to all patients to reduce the severity of curvatures and make the following treatment possible.Then total spine osteotomy and internal fixation were performed to rectify the remained deformity of the spine.Halo-pelvic distraction was maintained during the operation and postoperatively to limit the mobilization of the patients.At one day after the operation,the patients were able to get out of bed,stand up and move around,making nursing care more convenient.[Result]Between 1983 and 2003,a total of 185 cases of severe scoliosis were treated by this approach and an average correction rate of 70.32% was achieved.Complete bone fusions were achieved at the cut ends of thc bone.The average loss of correction rate was less than 5 degrees.In the late stage of postoperative duration,rod release occurred in four cases and was resolved by second surgical intervention,showing no adverse effect on the clinical outcome.At one year postoperative infective complication occurred in one case and the patient fully recovered after the removal of the inserted device.X-ray examination confirmed good healing of the hone grafts.Root pain occurred in one case and the patient gradually recovered without any medical intervention.None of the rest patients had evidence of spinal cord or nervous system complications.[Conclusion]Halo-pelvic distraction instrumenation,in combination with total spine osteotomy,is an effective treatment modality for severe spinal curvatures.Halo-pelvic distraction can facilitate the operative procedure for those cases that can not be cured by application of single instrumentation or have difficulty in the insertion of the internal fixation device.The combined total spine osteotomy can further correct the spinal curves,reduce the burden of the fixafion device and avoid the occurrence of release or break down of the rods,eventually cure the severe scoliosis effectively.

Posterior Correction with Segmental Pedicle Screw Fixation Alone in Severe Adolescent Idiopathic Scoliosis Over 70 degrees / 대한정형외과학회잡지

PURPOSE: To evaluate the results of a posterior procedure with segmental pedicle screw fixation in severe adolescent idiopathic scoliosis > or =70 degrees. MATERIALS AND METHODS: Twenty-three adolescent idiopathic patients with a curve magnitude > or =70 degrees subject to segmental pedicle screw fixation were analyzed retrospectively with a minimum follow-up of 2 years (2-7.8 years). There were 19 females and 4 males with a mean age of 14.9 years. All patients, except for 4 patients with King type I, were subjected to thoracic curve fusion. Twenty patients showed a thoracic curve > or =70 degrees (70-96), and 4 patients had a lumbar curve > or =70 degrees (70-77), preoperatively. The preoperative and postoperative standing roentgenograms were used to check the radiological parameters. RESULTS: The mean preoperative thoracic curve was corrected from 79.5+/-9.1 degrees to 25.3+/-5.8 degrees at the most recent follow-up, showing a correction of 67.9+/-7.8% and loss of correction of 2.5+/-1.9%. The mean preoperative lumbar curve was corrected from 72.3+/-3.3 degrees to 30.0+/-10.1 degrees at the most recent follow-up (58.4+/-14.8% curve correction, 2.4+/-2.5% loss of curve correction). The mean preoperative lowest instrumented vertebral tilting was corrected from 30.0+/-7.4 degrees to 10.5+/-5.6 degrees, showing a correction of 64.8+/-20.9%. The preoperative thoracic kyphosis improved from 28.3+/-11.2 degrees (0-50 degrees) to 35.0+/-9.1 degrees (22-53 degrees) postoperatively. There was neither pseudoarthrosis nor complications related to the pedicle screws at the most recent follow-up. CONCLUSION: Segmental pedicle screw fixation without an anterior release procedure in severe adolescent idiopathic scoliosis produced a satisfactory deformity correction with no significant loss of the curve correction. This procedure obviates the need for the anterior release and reduces the complications associated with anterior surgery.

Comparision of the pulmonary function between open anterior release and thoracoscopic anterior release / 대한척추외과학회지

STUDY DESIGN: Retrospective study OBJECTIVES: To evaluate the results of a serial pulmonary function test in severe scoliosis that required an anterior release and posterior fusion SUMMARY OF LITERACTURE REVIEW: There are a few reports on the pulmonary function after an anterior release and posterior fusion in severe scoliosis. MATERIALS AND METHODS: Twenty two cases of severe scoliosis requiring an anterior release and posterior fusion were followed up more than 2 years. The patients were divided into two groups (group 1: 10 cases of open thoracotomy and posterior fusion, group 2: 12 cases of thoracoscopic release and posterior fusion). The forced vital capacity (FVC), forced expiratory volume 1 (FEV1), total lung capacity (TLC), the predicted FVC, predicted FEV1 and predicted TLC in the preoperative, 3 month, 6 month, 1 year, 2 year postoperative period in the two groups were compared. Statistical analysis was performed using a paired T-test. RESULTS: The average preoperative FVC in groups 1 and 2 were checked as 2.20 L and 2.30 L, respectively. The postoperative 3 month FVC were checked as 1.60 L and 1.81 L, respectively, which were the lowest levels throughout the serial follow-up. The postoperative 6 month FVC were 1.70 L and 2.15 L, respectively. The postoperative 2 year FVC were 2.17 L and 2.18 L, respectively, which were 98.6% and 94.8% of the preoperative FVC. The average preoperative FEV1 of group 1 was 1.95 L. The post-operative 3 month FEV1 were at the lowest level and the postoperative 2 year FEV1 was 1.80 L (92.3% of preoperative value). The average preoperative FEV1 of group 2 was 2.05 L. The postoperative 6 month FEV1 was 1.90 L (92.7% of preoperative value). The TLC of group 2 showed a faster recovery than that of group 1. The predicted FVC, FEV1 and TLC of both groups at 2 years after surgery were 2 ~4% lower than the baseline. The recovery pattern in group 1 was steady for 2 years. The postoperative 6-month value was similar to the postoperative 2-year value in group 2. CONCLUSIONS: In severe scoliosis with a decreased pulmonary function, those undergoing thoracoscopic anterior release had a faster pulmonary function recovery than those undergoing an open thoracotomy.

Clinical Outcome After Surgical Correction of Severe Scoliosis / 대한정형외과학회잡지

PURPOSE: To determine the radiological, functional, and subjective outcome after stabilization in adult patients with severe scoliosis. MATERIALS AND METHODS: Eighteen adult patients with severe scoliosis underwent surgical correction. The radiological outcome was assessed by coronal and sagittal Cobb's angle, apical vertebral translation, and trunk deviation. The functional outcome was assessed by physical ability, locomotion, activities of daily living, and use of both hands. The subjective outcome was assessed by cosmetic satisfaction and costo-pelvic pain. RESULTS: Radiologically, mean correction of coronal curves were 28.7% in thoracic curves and 30.2% in lumbar. Average correction of sagittal curves were 29.4% and 16.8%, retrospectively. Mean correction of apical vertebral translation were 35% and 52.3%, retrospectively. Average correction of trunk deviation was 42.8%. In functional outcome, feeding ability and function of both extremities were improved significantly. 94.4% and 88.9% of patients were satisfactory significantly in cosmetic features and pain sensation. CONCLUSIONS: In this series, the surgical correction and stabilization of adult severe scoliosis resulted in much improvement in balancing of the trunk, improving function of upper extremities, and subjective satisfaction in the aspect of costo-pelvic pain and cosmesis.