| ObjectiveThe research was aimed to investigate the correlation between spinal imaging indexes and cardiopulmonary exercise endurance in moderate adolescent idiopathic scoliosis(AIS)in the coronal plane,and to identify the incidence of moderate cardiopulmonary exercise endurance reduction,so as to provide theoretical basis for the evaluation and rehabilitation of AIS cardiopulmonary exercise endurance,and provide reference for patients to carry out scientific and reasonable exercise.MethodsSixty-four patients with moderate AIS who met the admission criteria and were admitted to the in the Department of Rehabilitation Medicine of Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to June 2019 were included.There were 10 males(15.63%)and 54 females(84.37%),with an average age of(13.32±1.90)years and an average height of(158.79±7.33)cm.The mean body weight was(46.24±8.22)kg,the mean body fat rate was(22.92±5.11)%,the maximum Cobb angle was 20°~45°,and the maximum Cobb angle was(20.67±8.52)°,The severity,pulmonary function and cardiopulmonary endurance of scoliosis were evaluated.The imaging indicators of the patients were recorded,including the maximum Cobb angle,rotation index of the vertebral body of terminal vertebra Nash-Moe grade,number of involved vertebral bodies,posterior convex angle of thoracic vertebra,the direction of the scoliosis,Risser signs and different types of scoliosis.SPSS 25.0 and EmpowerStats software based on R language were used for statistical analysis.The K-S test was used to test the normal distribution of variables.The comparison of basic information between patients of different genders and the comparison of pulmonary function and cardiopulmonary exercise test(CPET)indicators of patients with different scoliosis directions were performed independently.The student t test was used to analyze the scoliosis imaging parameters and pulmonary function and CPET indicators by Pearson correlation or Spearman correlation analysis.The number of vertebral bodies involved,the direction of scoliosis and different types of scoliosis were classified variables.After dummy variables were set,With the relevant pulmonary function and CPET indicators as the dependent variables,various dummy variables were included,and the significant indicators in the correlation analysis were selected as the independent variables.After adjusting for the possible confounders of height,weight,gender and age,stepwise multiple linear regression was conducted.The correlation between the imaging indicators of AIS patients and pulmonary function and cardiopulmonary exercise endurance were analyzed and discussed,and the determination coefficient(R2)was obtained.Taking cardiopulmonary exercise endurance level as the dependent variable and binary results,The percentage of the expected peak oxygen uptake(PeakVO2% pred)≥84% was defined as normal,assigned a value of "0",PeakVO2% pred <84% was defined as reduced,assigned a value of "1",and the Cobb angle as an independent variable.After adjusting for possible confounding factors of gender,age,height,and weight,a two-stage linear regression model was used to explore whether there was a non-linear relationship between Cobb angle and cardiopulmonary endurance.A difference of P <0.05 was statistically significant.Results(1)The results showed that 39 patients with normal cardiopulmonary exercise endurance accounted for 60.94%;25 patients with decreased cardiopulmonary exercise endurance accounted for 39.06%;AIS patients with main chest curvature were divided into left chest curvature group and the right chest curvature group.The comparison between the groups showed that the forced expiratory volume occupancy vital capacity ratio(FEV1/FVC)in the right chest curvature group was significantly lower than that in the left chest curvature group,and the difference was statistically significant(P=0.028<0.05).There was no significant difference in other pulmonary function and CPET indicators in different scoliosis directions(P>0.05);(2)Linear regression analysis showed that Cobb angle was significantly negatively correlated with VT(β=-0.013,P <0.05),and Cobb angle was significantly positively correlated with RR(β= 0.421,P <0.05),Different scoliosis positions associated with FVC in patients,FVC in thoracolumbar curvature patients was significantly lower than that in patients with lumbar curvature.Risser sign was associated with VT,FEV1 and VO2/HR,and the standard partial regression coefficient respectively were 0.036,0.083 and 0.646(P <0.05),No correlation was found between the imaging indicators of scoliosis and the relative peak oxygen uptake(PeakVO2(ml/kg/min))and the VEmax;(4)The confounding factors were adjusted.The results showed that the Cobb angle of patients had a non-linear relationship with cardiopulmonary endurance.With the segment linear regression model analysis,the inflection point was calculated as 34°.When the Cobb angle >34°,the probability of cardiopulmonary endurance decreased by 1.399 times(β=1.399,95% CI=1.003-1.952)for every one degree increased,the difference is significant(P=0.048 <0.05),When the Cobb angle≤34°,the probability of decreased cardiopulmonary endurance increased by 0.873 times(β=0.873,95%CI=0.752-1.014)for every one degree increase,and the difference was not statistically significant(P=0.076<0.05).ConclusionsThe incidence of cardiopulmonary endurance in patients with moderate adolescent idiopathic scoliosis was 39.06%.The pulmonary function of patients with right chest curve was worse than that of left chest curve.The pulmonary function of thoracolumbar curve patients was lower than that of patients with lumbar curves.Scoliosis severity was related to the patient’s pulmonary ventilation during exercise,The severity of scoliosis had a significant negative correlation with tidal volume and a significant positive correlation with respiratory frequency.Bone maturity had a significant positive correlation with pulmonary function and ventilation during exercise.AIS patients with Cobb> 34 ° had a high risk of reduced cardiopulmonary endurance.Therefore,it is recommended that these patients be evaluated for cardiopulmonary endurance to promote psychosomatic health and rehabilitation intervention. |
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