Нейромышечные сколиозы у детей: хирургическое лечение и функция легких (аналитико-систематический обзор)

Цель исследования. Систематический анализ современных публикаций, посвященных хирургической коррекции нейромышечных сколиозов у детей и ее связи с функцией легких.

Материал и методы. Поиск научных источников осуществляли в соответствии с PRISMA. Протокол разработан априорно, в международных регистрах систематических обзоров не регистрировался. Поиск производился в базах данных PubMed/Medline, Scopus, Cochrane Library, Google Scholar, eLibrary, КиберЛенинка, РУКОНТ. Из 938 записей, обнаруженных в базах данных, в обзор включены 69 работ.

Результаты. Важнейшим положительным эффектом хирургической коррекции деформации позвоночника при нейромышечном сколиозе в отношении функции легких считается не регресс дыхательных нарушений, а их стабилизация или замедление прогрессирования. Основное противоречие заключается в том, что метод, обеспечивающий максимальную коррекцию и стабильность
(задний инструментальный и костный спондилодез), у растущих детей необратимо останавливает рост позвоночника и грудной клетки, потенциально ограничивая развитие легких. В то же время технологии сохранения роста сопряжены с ожидаемо меньшей одномоментной коррекцией деформации при более высокой частоте запланированных послеоперационных осложнений, тяжесть которых тем не менее несравнимо меньше, чем при заключительном спондилодезе. Данные об эффективности многих рост-сберегающих систем (Shilla, Luque trolley) при нейромышечном сколиозе остаются фрагментарными.

Заключение. Анализ хирургических методик коррекции нейромышечного сколиоза и их влияния на дыхательную функцию пациентов демонстрирует дефицит и противоречивость данных; отсутствуют единые критерии оценки функции дыхания; когорты пациентов различаются по нозологии нейромышечного сколиоза, прогнозу основного заболевания, тяжести функционального статуса, возрасту и величине деформации.

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