术前大质量Halo-股骨髁上牵引在治疗僵硬型特发性脊柱侧凸中的应用

目的 探讨术前快速大质量Halo-股骨髁上牵引在治疗僵硬型特发性脊柱侧凸中的应用价值.方法 对2003年7月至2006年5月行术前快速大质量Halo-股骨髁上牵引治疗且临床资料完整的16例僵硬型特发性脊柱侧凸患者进行回顾性分析.其中男性4例,女性12例;年龄12～20岁,平均16岁,术前冠状面Cobb角平均111°,胸椎后凸(T_(5～12))平均64°.术前行Halo-双侧股骨髁上牵引,最大质量(可达体质量的1/2)牵引2～3周后,行后路矫形内固定融合术.对术前Bending像、牵引后和术后侧凸纠正率进行比较.结果 随访12～60个月(平均36个月).最大牵引质量平均19 kg,为体质量的35%～56%.1例患者在牵引12 d后出现右侧臂丛神经麻痹,减轻牵引质量后逐渐恢复.矫形术后无瘫痪、死亡等并发症,无呼吸衰竭的发生.术前平卧位Bending像X线片的侧凸纠正率平均18.7%,Halo-股骨髁上牵引后侧凸纠正率平均达31.9%.与Bending像相比,牵引后侧凸纠正率提高了13.2%,差异具有统计学意义(P<0.05).后路矫形术后侧凸矫正率平均为48.6%,胸椎后凸矫正率平均为51.9%.末次随访时冠状面矫正丢失率平均为2.0%,矢状面矫正丢失率平均为5.8%.结论 术前短时间大质量Halo-股骨髁上牵引结合后路广泛松解可改善僵硬型特发性脊柱侧凸畸形矫形率,但应注意与牵引相关的并发症.

Efficacy of preoperative Halo-femoral traction in the treatment of rigid idiopathic scoliosis

Objective To evaluate the efficacy of preoperative Halo-femoral traction in the treatment of rigid idiopathic scoliosis.Methods Sixteen patients with rigid idiopathic seoliosis treated with Halo-femoral traction before posterior spine fusion from July 2003 through May 2006 were studied retrospectively.There were 4 male and 12 female,with a mean age of 16 years(range,12-20 years).The coronal Cobb ansles of coronal major curve and the thoracic kyphosis(T_5-T_(12))were 111°and 64°,respectively.All the patients underwent preoperative Halo-femoral traction.After the maximum weight traction for 2-3 weeks,a posterior instrumentation and fusion was performed.The correction rate of coronal major curve on preoperative side bending film,on supine film after Halo-femoral traction and after surgery was compared.Results The maximum traction weight averaged 19 kg.All patients had an at least 12-month follow-up.One patient experienced transient brachial plexus palsy and complete recovery was achieved after reducing the traction weight.No neurologic complication,death and respiratory failure occurred after surgery.In comparison to the correction rate of 18.7%on preoperative side bending film,the correction rate of coronal major curve after Halo-femoral traction increased by 13.2%(P<0.05).,The postoperative correction rate of coronal major curve and thoracic kyphosis was 48.6%and 51.9%,respectively.At the final follow-up,the coronal and sagittal correction loss averaged 2.0%and 5.8%,respectively.Conclusions Preoperative Halo-fomoral traction combined with intraoperative posterior spinal release can significantly enhance the correction rate for rigid idiopathic acoliosis.However,the traction complications should be worthy of vigilance.