Abstract
Background: The aim of the study was to compare the effects of conventional posterolateral thoracotomy and muscle-sparing posterolateral thoracotomy on pulmonary and muscle strength. Methods: From January 2003 to December 2004, 50 randomized patients with a diagnosis of primary lung cancer underwent pulmonary resection. The patients were divided into two groups: Group I (n = 25) underwent conventional posterolateral thoracotomy, while Group II (n = 25) had muscle-sparing thoracotomy. The groups were compared in terms of shoulder abduction/adduction isokinetic muscle strength and respiratory muscle strength. Results: A comparison of maximal expiratory pressure and maximal inspiratory pressure preoperatively and postoperatively and of maximal expiratory pressure and maximal inspiratory pressure preoperatively and at 3 months postoperatively showed statistically significant differences (p < 0.05). Conclusion: For the preservation of muscle strength, especially in patients whose jobs involved manual work, muscle-sparing posterolateral thoracotomy should be the first choice rather than conventional thoracotomy. Moreover, if necessary, the latissimus dorsi muscle can be used more extensively as a flap after muscle-sparing posterolateral thoracotomy procedures.
Key words
thoracic surgery - posterolateral thoracotomy - muscle sparing - surgery/incisions - thoracotomy - rehabilitation - pulmonary function
References
-
1
Hazelrigg S R, Landreneau R J, Boley T M et al.
The effect of muscle-sparing versus standard posterolateral thoracotomy on pulmonary function, muscle strength, and postoperative pain.
J Thorac Cardiovasc Surg.
1991;
101
394-401
-
2 Murthy S C, Rice T W. Thoracic incisions. Pearson FG, Cooper JD, Deslauriers J, Ginsberg JR, Hiebert C, Patterson GA, Urschel HC Thoracic surgery. 2nd ed. New York; Churchill Livingstone 2002: 120-139
-
3 Dvir Z. Isokinetics. Hardware, test parameters, and issues in testing. Dvir Z Muscle testing, interpretation and clinical applications. 2nd ed. New York; Churchill Livingstone 1995: 1-79
-
4 Perrin H D. Isokinetic instrumentation. Perrin HD Isokinetic exercise and assessment. West Yorkshire; Human Kinetics Publishers 1993: 1-212
-
5 Basyigit I. Spirometrik inceleme. Ilgazlı A, Cağlar T Solunum Fonksiyon Testleri ve Klinik Kullanımları. Istanbul; Nobel Tıp Kitapevleri 2004: 31-51
-
6
Nomori H, Horio H, Iga R, Shouyama Y, Kobayashi R.
Postoperative changes of maximum inspiratory and expiratory pressures in 3 pneumonia cases occurring after surgery for empyema.
Kyobu Geka.
1996;
6
445-448
-
7
Nomori H, Kobayashi R, Fuyuno G, Morinaga S, Yashima H.
Preoperative respiratory muscle training. Assessment in thoracic surgery patients with special reference to postoperative pulmonary complications.
Chest.
1994;
6
1782-1788
-
8
Furrer M, Rechsteiner R, Eigenmann V, Signer C, Althaus U, Ris H B.
Thoracotomy and thoracoscopy: postoperative pulmonary function, pain and chest wall complaints.
Eur J Cardiothorac Surg.
1997;
12
82-87
-
9
Nakata M, Saeki H, Yokoyama N, Kurita A, Takiyama W, Takashima S.
Pulmonary function after lobectomy: video-assisted thoracic surgery versus thoracotomy.
Ann Thorac Surg.
2000;
70
938-941
-
10
Mayer F, Horstmann T, Rocker K, Heitkamp H C, Dickhuth H H.
Normal values of isokinetic maximum strength, the strength/velocity curve, and the angle at peak torque of all degrees of freedom in the shoulder.
Int J Sports Med.
1994;
15
19-25
-
11
Akçalı Y, Demir H, Tezcan B.
The effect of standard posterolateral versus muscle-sparing thoracotomy on multiple parameters.
Ann Thorac Surg.
2003;
76
1050-1054
-
12
Van Meeteren J, Roebroek M E, Stam H J.
Test-retest reliability in isokinetic muscle strength measurements of the shoulder.
J Rehabil Med.
2002;
34
91-95
-
13
Mayer F, Horstmann T, Kranenberg U, Rocker K, Dickhuth H H.
Reproducibility of isokinetic peak torque and angle at peak torque in the shoulder joint.
Int J Sports Med.
1994;
15
26-31
-
14
Kutlu C A, Akin H, Olcmen A, Biliciler U, Kayserilioğlu A, Ocmen M.
Shoulder-girdle strength after standard and lateral muscle-sparing thoracotomy.
Thorac Cardiov Surg.
2001;
49
112-114
-
15
Khan I F, McManus K G, McCraith A, McGuigan J A.
Muscle-sparing thoracotomy: a biomechanical analysis confirms preservation of muscle strength but no improvement in wound discomfort.
Eur J Cardiothorac Surg.
2000;
18
656-661
Dr. Serhan Tanju
Department of Thoracic Surgery
Istanbul Universty Istanbul Medical School
Capa
Millet St
34390 Istanbul
Turkey
Email: drstanju@hotmail.com
