Surgical treatment of congenital kyphosis

STUDY DESIGN: In this study, 26 cases of congenital kyphosis and kyphoscoliosis treated surgically were retrospectively reviewed. OBJECTIVE: To assess the clinical outcomes and surgical indications for posterior only versus anteroposterior surgery in the child. SUMMARY OF BACKGROUND DATA: Congenital kyphosis usually is progressive without surgical intervention. Current recommended treatment includes posterior arthrodesis for deformities of less than 50 degrees to 60 degrees, and anterior release or decompression, anterior fusion, and posterior instrumented arthrodesis for large deformities and cord compression. METHODS: Cases involving myelodysplasia, spinal dysgenesis, and skeletal dysplasia were excluded from the study. Kyphoscoliosis was included if the kyphotic deformity was greater than the scoliotic deformity. Patients were grouped by age and surgical technique. The patients in group P1 underwent posterior arthrodesis at an age younger than 3 years, and those in group P2 underwent the procedure at an age older than 3 years. The patients in group AP1 underwent anterior and posterior procedures at an age younger than 3 years, and those in group AP2 underwent the procedures at an age older than 3 years. The preoperative deformity, complications, and postoperative deformity correction were analyzed. There were nine Type 1 (failure of formation), nine Type 2 (failure of segmentation), and eight Type 3 (mixed) deformities. Four patients had associated spinal dysraphism. Three patients with Type 1 deformities had clinical or radiographic evidence of cord compression. RESULTS: In Group P1, five patients at an average age of 16 months underwent posterior arthrodesis alone for an average kyphotic deformity of 49 degrees. The immediate postoperative correction improved over a period of 6 years and 9 months by an additional 10 degrees, resulting in a final deformity of 26 degrees. Pseudarthrosis developed in two patients, requiring fusion mass augmentation or anterior arthrodesis. Neither patient was instrumented. In Group P2, five patients at an average age of 13 years and 7 months underwent posterior arthrodesis with instrumentation for kyphotic deformity of 59 degrees. Approximately 30 degrees of intraoperative correction was achieved safely using compression instrumentation and positioning. No further correction occurred with growth. The final residual kyphotic deformity was 29 degrees after a follow-up period of 4 years and 5 months. In Group AP1, seven patients underwent anterior release or vertebra resection for deformity correction and posterior arthrodesis for an average kyphotic deformity of 48 degrees at the age of 16 months. There were no iatrogenic neurologic injuries. The final residual kyphotic deformity was 22 degrees after a follow-up period of 6 years and 3 months. In Group AP2, nine patients underwent anterior release or decompression with posterior arthrodesis for kyphotic deformity of 77 degrees at the age of 11 years and 6 months. The deformity was corrected to 37 degrees, with no significant loss over a follow-up period of 5 years and 2 months. There were two postoperative neurologic complications. CONCLUSIONS: After reviewing their experience, the authors made the following observations: 1) The pseudarthrosis rate was low even without routine augmentation of fusion mass if instrumentation was used; 2) gradual correction of kyphosis may occur with growth in patients younger than 3 years with Types 2 and 3 deformities after posterior fusion, but appears to be unpredictable; 3) the risk of neurologic injury with anterior and posterior fusion for kyphotic deformity was associated with greater age, more severe deformity, and preexisting spinal cord compromise.     

Thoracoscopic interventions in deformities of the thoracic spine

AIM OF THE STUDY: We prospectively studied 9 patients with deformities of the thoracic spine who underwent thoracoscopic surgery to critically evaluate the benefits and limitations of thoracoscopy. METHODS: Seven patients with deformities of the thoracic spine (5 scoliosis, 2 kyphosis) underwent a thoracoscopic release and posterior correction and fusion in a single stage. In one case of a crankshaft-phenomenon a thoracoscopic epiphyseodesis und in another case of a posttraumatic kyphosis a thoracoscopic instrumentation and fusion were performed. The average age was 21 years, the follow-up was 18 months with a minimum of 12 months. The perioperative data including complications were collected and a radiographic analysis concerning curve correction was carried out. RESULTS: The scoliotic curves measured preoperatively 84 degrees on average with a Cobb angle of 62 degrees on the traction films and were corrected by 57% to averagely 36 degrees at follow-up. In the two cases of Scheuermann kyphosis a preoperative kyphosis of 94 degrees respectively 82 degrees was corrected to 52 degrees respectively 58 degrees. Between 4 and 5 discs were excised with an average operative time of 160 min and a blood loss of 380 ml. A conversion to open thoracotomy was not necessary in any case. There were no intraoperative neurovascular complications. CONCLUSIONS: Thoracoscopic procedures in deformities of the thoracic spine are technically demanding; however, it is a minimally invasive procedure with a reduced approach-related morbidity compared to open thoracotomy. The indications for a thoracoscopic release are rigid kyphosis and scoliosis with rigid curves between 80 and 90 degrees Cobb angle in which an anterior correction and instrumentation alone is not considered.     

Long-term results of posterior release surgery for severe flexion contracture of the knee in patients with rheumatoid arthritis

Twelve knees in nine rheumatoid patients with severe flexion contractures were evaluated clinically and roentgenographically for an average of 17.2 years (range, six to 25 years) after posterior release surgery. Preoperatively, the average extension in the 12 knees was 42.5 degrees, and postoperatively it was 10.8 degrees. Even though patients were able to walk postoperatively, the majority had knee pain when they extended their knees soon after surgery. Seven knees required further surgery after correction of the flexion deformity. The average time before reconstructive surgery after posterior release was 11.1 months. In the treatment of severe flexion deformities of the knee in patients with rheumatoid arthritis, posterior release surgery was effective only in correcting the deformity. Posterior subluxation of the tibia, knee pain, and instability occurred soon after surgery. Therefore, patients may require additional reconstructive surgery soon after the posterior release.     

胸腰段陈旧骨折继发后凸畸形的外科治疗

目的总结分析胸腰段陈旧骨折继发后凸畸形的手术治疗效果。方法回顾研究胸腰段陈旧骨折继发后凸畸形33例,平均年龄40 3岁。病史平均36 0个月。后凸Cobb角平均40 8°(20°~82°)。全部患者均有脊髓损伤,括约肌功能障碍26例。12例有显著腰背部疼痛。23例既往曾有手术史。手术方式包括前路椎体间隙松解植骨+后路截骨矫形固定15例,后路截骨减压矫形12例,前路松解、椎体间撑开植骨固定6例。结果全部患者后凸畸形矫正率平均为86 0%。无严重手术并发症。随访时间平均24 6个月(6个月~84个月), 32例骨性融合, 1例植骨未融合,行二次手术后骨性融合。10例术后神经功能有改善, 10例术后括约肌功能部分恢复。有显著腰背部疼痛者术后症状均明显减轻。结论单纯后路截骨矫形适用于角度较小( <45°)的后凸畸形。前路松解、后方经关节突截骨矫形适用于不同程度的后凸畸形,尤其对后凸严重或二次手术的病例更显优势。对于合并脊髓不全损伤的病例即使病史较长,手术仍然可能获得一定疗效,特别是对于腰部疼痛的缓解效果显著。     

Treatment of severe kyphosis in myelomeningocele by segmental spinal instrumentation with Luque rods

Myelomeningocele leads to kyphosis of the dysplastic spine in 12-20% of cases, resulting in a severe gibbus. In three patients (at the age of 9, 13 and 16 years) with a thoracolumbar kyphosis (90 degrees, 120 degrees and 95 degrees respectively), and a compensatory thoracic lordosis (35 degrees, 105 degrees and 90 degrees) a resection or a wedge osteotomy of the gibbus was performed with segmental sublaminar wire fixation to Luque rods. In addition, a spondylodesis with autogenous bone and an allograft was performed. Correction of the kyphosis (to 30 degrees, 60 degrees and 50 degrees) and lordosis (to 15 degrees, 65 degrees and 55 degrees) was attained. This posterior procedure was sufficient for correction; there was no need for an anterior release. Cord and dura were left intact. During follow-up (27, 60 and 30 months) no progression of the curves has been noted. This one-stage posterior correction with L-rod fixation proved to be a method of choice for this difficult-to-treat spinal deformity.     

Transposition of the posterior tibial tendon

The posterior tibial tendon was rerouted by the technique described by Baker and Hill in 35 feet of children with a dynamic varus deformity due to spastic cerebral palsy. The average follow-up period was 11.4 years. In ten of the feet, rerouting of the posterior tibial tendon was the only procedure performed. Eight of the ten feet obtained a satisfactory correction. There were no overcorrection problems in these ten feet. In the remaining 25 feet, the Baker-Hill procedure was done concurrently with other procedures, such as lengthening of the triceps surae (22 feet), calcaneal osteotomy (two feet), or plantar fascia release (two feet). The dynamic equinovarus deformity was corrected in all 25, but three subsequently developed a cavus deformity. This was probably caused by excessive weakening of the triceps surae rather than transposition of the posterior tibial tendon. Based on this study, anterior rerouting of the posterior tibial tendon seems to be a simple, safe, and generally effective procedure for correction of dynamic varus of the spastic hindfoot in children with cerebral palsy.     

Posterior tibial tendon transfer and tendo-Achilles lengthening for equinovarus foot deformity due to severe crush injury

Surgical correction was performed on nine patients who had equinovarus deformity caused by severe crush injury of the leg sustained in an earthquake. The operative procedure used involved the transfer of the posterior tibial tendon to the dorsum of the foot by passing it through the interosseous membrane using a modified procedure as published in 1978. This procedure was combined with percutaneous Achilles tendon lengthening and tenotomy of toe flexors when needed. The average follow-up time after the operation was 21 months. The treatment improved the heel-toe steppage gait in all patients and all were able to walk in standard shoes. There were no complications in the postoperative period. Recurrence of varus deformity was not seen in any of the patients. They had active dorsiflexion of the foot, with a median active dorsiflexion of 5 degrees (0 to 10 degrees) and median active plantarflexion of 16.1 degrees (10 to 25 degrees) compared to the median active dorsiflexion and plantarflexion on the uninvolved side. The total range-of-motion was 21.1 degrees (10 to 35 degrees).     

Adult idiopathic scoliosis treated by anterior and posterior spinal fusion

Twenty-six adults, ranging in age from nineteen to fifty-eight years old, were treated for idiopathic scoliosis by two-stage anterior and posterior spinal fusion. The goals of the combined procedure were to increase correction of the curve and decrease the rate of pseudarthrosis. Preoperatively, the major curves measured an average of 83 degrees, and on the best side-bend they averaged 59 degrees, a 29 per cent degree of flexibility. At the time of discharge from the hospital the curves had improved to an average of 44 degrees, a correction of the preoperative curve of 39 degrees or 47 per cent. At an average length of follow-up of forty-nine months, the major curves measured an average of 50 degrees, a 41 per cent correction compared with the initial curves. Twenty-three of the major curves were better than when they were measured on the preoperative radiograph of the best side-bend, by an average of 15 degrees, but eight curves were either the same or worse. No patient had pseudarthrosis or permanent neurological injury. It is our conclusion that a two-stage anterior and posterior fusion is of value for the treatment of the adult who has a rigid curve that requires maximum correction to allow the head, shoulders, and torso to be centered over the pelvis. We do not recommend the use of instrumentation for the anterior fusion as this did not increase the correction of the curve in this series of patients.     

TSRH内固定治疗脊柱侧凸

目的　回顾性研究TSRH(TexasScottishRiteHospital)脊柱内固定系统在治疗脊柱侧凸的临床疗效。 方法　对 1998年 1月至 2 0 0 0年 12月手术治疗的 12 9例脊柱侧凸患者 ,总结其侧弯矫形、脊柱平衡、并发症及 3年以上的随访结果。根据手术方法不同 ,共分为 4组。A组 :单纯脊柱后路融合固定术 ;B组 :单纯脊柱前路融合固定术 ;C组 :分期前、后路融合固定术 ;D组 :Ⅰ期前、后路融合固定术。四组患者均应用TSRH内固定系统。手术时平均年龄 14 .2岁 (6～ 5 5岁 ) ,平均随访 34个月。结果　A组 :78例病人行单纯脊柱后路融合TSRH内固定 ,术后平均矫形率为6 3.4 %。随访 38个月 (2 4～ 5 0个月 ) ,平均矫形丢失 7°,矫形丢失率平均 9.5 %。本组并发症发生率为 12 .8% ,包括 3例脱钩 ,3例螺钉断裂 (共 6枚螺钉 ) ,1例术后侧弯失代偿 ,1例术后发生曲轴现象。B组 :2 2例患者行单纯脊柱前路融合、短节段TSRH内固定 ,平均矫形率为 74 .8%。平均随访 36个月 ,平均矫形率丢失 5 %。 2例发生一过性交感神经损伤。术后 6个月内均自然恢复。C组 :17例有 90°以上的侧弯 ,且Bending像上侧弯仍大于 7°的患者行前路松解 ,2～ 3周后再行后路融合TSRH内固定。本组平均手术时间 8.3h ,出血 935ml,输血 6 83ml,平均矫形 33.6°,矫     

Long-term results of surgical treatment for clubfoot with the posterior release method]

The authors present long term results of congenital clubfoot by posterior release. Our material consisted of 57 patients, with 57 clubfeet, 5 to 27 months old (mean age 9.5 months) at the time surgery. The age at the time of the final follow-up ranged from 8 to 20 years (mean age 14.7 years). The time of the observation ranged from 7 to 20 years (mean 13.9 years). Final results were evaluated according to the Magone classification. Basing on this classification we achieved very good results in 21.3%, good results in 29.3%, sufficient results in 26.7% and poor results in 22.6%. In the authors opinion posterior release and Achilles tendon elongation give the best possibility of correction of residual deformation. Varus deformity, abduction and equinal position should not be treated by posterior release.     

Tibialis posterior transfer by interosseous route for the correction of foot drop in leprosy

This article summarises a prospective study to evaluate the long-term results produced by interosseous transfer of the tibialis posterior tendon for the correction of foot drop due to leprosy neuritis. The study was carried out in 120 feet in 69 patients. All patients had closed elongation of the tendo Achillis (ETA) before transfer of the bifurcated tibialis posterior tendon through the interosseous route to the tendons of tibialis anterior and peroneous tertius or brevis over the dorsum of feet. At final follow-up of average 24 months, all the patients with ETA had a significantly greater range of active dorsiflexion of more than 10° above 90°, which was not merely from the tenodesing effect. The results, in terms of improvement in gait and prevention of trophic changes, remained satisfactory. An interosseous route is preferred with split attachment to the tibialis anterior and to the peroneus brevis or tertius tendons.     

重度脊柱侧凸治疗中神经并发症的防治对策

目的探讨重度脊柱侧凸手术治疗中神经系统并发症的防治方法。方法手术治疗Cobb角大于80°的脊柱侧凸患者71例。术前侧凸角平均96．6°（80°～135°）,31例患者同时有脊柱后凸,平均后凸角83．0°（52°～145°）。行后路节段椎弓根螺钉固定14例,后路顶椎楔形截骨21例,分期手术34例,前后路联合手术2例。术中应用SEP和唤醒试验双向监测61例,单独唤醒试验10例。结果术后平均侧凸角39．6°（矫正率59．2％）,平均后凸角31．9°（矫正率61．6％）。39例患者术后平均随访51个月（5～81个月）,其中33例患者植骨融合良好,矫正丢失率平均2．1％,2例因内固定断裂再次手术。术前有神经功能障碍的8例患者中,除4例脊髓灰质炎后遗症外,3例完全恢复,1例大部分恢复。术后出现神经功能障碍5例,4例完全恢复,1例部分恢复。结论头颅骨盆环和脊椎截骨技术是提高重度脊柱侧凸矫正率、降低神经并发症的有效方法;术中唤醒试验配合SEP监测能较早提示神经系统损伤;对出现神经系统损伤患者,术后早期使用脱水药和激素有利于神经功能恢复。     

Total knee arthroplasty ligament balancing and gap kinematics with posterior cruciate ligament retention and sacrifice

This cadaver study was undertaken to gain insight into the effects that posterior cruciate ligament retention and sacrifice would have on the amount of deformity correction obtained with medial and lateral structure release during total knee arthroplasty. Twenty-seven cadaveric specimens were used to sequentially release medial and lateral structures with and without posterior cruciate support. Each release sequence was tested in full extension and 90 degrees flexion. In full extension, the resulting change into valgus after release of the posterior cruciate ligament, posteromedial capsule/oblique ligament complex, superficial medial collateral ligament, and pes anserinus and semimembranosus tendons was 6.9 degrees, and it increased to 13.4 degrees in 90 degrees flexion. With preservation of the posterior cruciate ligament this decreased to 5.2 degrees in extension and 8.7 degrees in flexion. Changes seen in 90 degrees flexion were significantly greater than those in full extension. For the valgus knee model with release of the posterior cruciate ligament, posterolateral capsule, lateral collateral ligament, iliotibial band, popliteus tendon, and lateral head of the gastrocnemius, 8.9 degrees of change into varus was seen in extension and 18.1 degrees in 90 degrees flexion. With posterior cruciate ligament retention 5.4 degrees and 4.9 degrees of change into varus was seen in extension and flexion, respectively. Significantly less change with retention of the posterior cruciate ligament was seen with both medial and lateral release and more opening of the flexion gap was seen on the release side of the joint for all groups except those with lateral release with sacrifice of the posterior cruciate ligament.     

关节镜下行(足母)外翻外侧松解背侧入路的研究

目的探讨关节镜下行躅外翻外侧松解背侧入路的可行性及方法。方法解剖研究采用10具新鲜保留踝关节的足部标本。在关节镜监视下,以钩刀松解外侧关节囊和躅内收肌斜头。观察各入路与周围神经血管、肌腱之间的关系,并统计松解范围。临床研究对5例躅外翻患者行关节镜下外侧松解加内侧软组织紧缩手术,患者均为女性,平均年龄30岁。术前躅外翻角为24^o-38^o,平均30^o,跖间角为9^o-11^o,平均10^o。结果解剖研究近侧切口与躅短伸肌腱非常接近,为0—3mm,平均1．5mm;与躅长伸肌腱相距为1—4mm,平均2．4mm。远侧切口与第一趾背动脉和趾背神经非常接近,为1～3mm,平均1、4mm,极易损伤。6例正常足中,1例松解跖籽骨韧带,1例作部分松解（70％）。在4例足母外翻足中,2例松解跖籽骨韧带,1例作了部分松解（50％）。临床研究5例患者平均随访时间9个月。最后一次随访时X线片示足母外翻角4^o-9^o,平均7^o,跖间角8^o～10^o,平均9^o。患者均恢复良好,对外形满意,未见肌腱损伤、麻木、感染、跖趾关节僵硬等并发症发生。结论背侧入路关节镜下外侧松解是可行的,其手术切口较小,镜下视野清晰,可以根据需要松解外侧结构的各个部分,由于不损伤血管,减少了跖骨头坏死的发生。     

Lateral column lenghtening by calcaneal osteotomy combined with soft tissue reconstruction for treatment of severe posterior tibial tendon dysfunction. Technique and preliminary results

The purpose of this paper is to present principle and technique of proximal lateral column lengthening by calcaneal osteotomy and to critically analyze our preliminary results. 16 patients (7 female, 9 male; average age 52.3 years [24-72 years]) were treated for stage II to III posterior tibial tendon insufficiency by calcaneal osteotomy and medial soft tissue reconstruction (tendon reconstruction, 15; tendon transfer, 8; deltoid ligament repair, 10). When the AOFAS Ankle-Hindfoot Rating Scale was applied, these patients were shown to have significantly increased their scores from an average preoperative value of 49.1 to a mean postoperative value of 91.1 after a mean follow-up of 24.6 months. In all but one case no loss of achieved foot correction was noted. In one case, a fusion of the calcaneocuboid joint had to be performed after 5 months due to painful degenerative joint disease. At follow-up, all patients had satisfactory restoration of their medial longitudinal arch, reduction of forefoot abduction, and restored arch height. All patients were able to fully weight-bear the operated foot, and all patients were satisfied with the achieved result. In the pes planovalgus deformity occurring in stage II to III (as significant degenerative joint disease has not already occurred), osteotomies appear to have a significant role in the operative management and to function by restoring more normal biomechanics, thus allowing tendon reconstruction and tendon transfers to return to successful function.     

退行性脊柱侧凸三维矫形术并发症的探讨

目的:探讨使用椎弓根螺钉系统矫治退行性脊柱侧凸的并发症及其预防措施。方法:对82例退行性脊柱侧凸患者采用4种不同的手术方式:17例先行一期前路松解、支撑性融合,二期后路多节段椎弓根螺钉矫形,后外侧植骨融合;41例行后路椎管减压、椎体间支撑融合(PLIF)、椎弓根螺钉矫形内固定 后外侧植骨融合术;14例行后路短缩、椎管减压、椎弓根螺钉矫形内固定 后外侧植骨融合术;10例行椎管减压、椎弓根矫形内固定 后外侧植骨融合术。对75例获得6个月至4年(平均2年3个月)随访患者的并发症进行回顾性分析。结果:本组无围手术期死亡,术后重症监护时间平均22h,切口感染1例,切口延迟愈合4例;7例术后出现肺部感染,经处理后好转;6例手术后出现心脏病复发,经内科联合处理后好转;9例术后出现双下肢疼痛,经保守治疗3个月症状缓解;4例腰背部疼痛缓解不明显。无断钉、断棒现象。88.6%的患者对手术治疗的结果满意。结论:三维矫形手术治疗退行性脊柱侧凸的并发症较多且严重,手术治疗需慎重考虑患者的全身情况及术前症状,以选择适合的手术方式。     

Recognition and treatment of refractory posterior capsular contracture of the shoulder.

SUMMARY: Limitation of internal rotation has been reported in conjunction with impingement syndrome of the shoulder. A group of 9 patients was identified who had discrete, painful loss of internal rotation associated with refractory impingement syndrome. The duration of symptoms averaged 18 months (range, 11 to 33 months), and all patients failed a course of physical therapy specifically addressing loss of internal rotation. Six patients reported traction as the mechanism of injury, and 3 developed motion loss and pain following a posterior capsular shift procedure. All patients underwent arthroscopy, and were observed to have a thickened posterior capsule. An arthroscopic release of the posterior capsule improved motion in all patients, with substantial relief of pain. At an average of 19 months follow-up (range, 11 to 35 months), internal rotation in 90 degrees of abduction improved from 10 degrees preoperatively to 47 degrees postoperatively, and there were no complications related to the procedure. We conclude that chronic loss of internal rotation secondary to posterior capsular contracture may be an explanation for refractory pain in some patients with an initial diagnosis of impingement syndrome. This condition appears to be amenable to arthroscopic posterior capsular release.     

Lengthening of the lateral column and reconstruction of the medial soft tissue for treatment of acquired flatfoot deformity associated with insufficiency of the posterior tibial tendon.

We analyzed our results of surgery for acquired flatfoot deformity after dysfunction of the posterior tibial tendon. This included lengthening the proximal lateral column by calcaneal osteotomy and reconstructing the medial soft tissue. Nineteen patients (9 women and 10 men; average age, 52.9 years [range, 24-72 years]) were treated for stage II and stage II-III insufficiency of the posterior tibial tendon. The medial soft tissue surgery included 18 reconstructions of the tendon, 11 transfers of the flexor digitorum longus tendon, 13 repairs of the deltoid ligament, and 3 repairs of the spring ligament. At follow-up (mean, 23.4 months), all patients had satisfactory restoration of their medial longitudinal arch, reduction of abduction in the forefoot, and restored height in the arch. All patients were able to bear weight fully on the foot that underwent surgery, and all but one were satisfied with the result achieved. The clinical result was rated as excellent in 6, good in 11, and fair in 2 cases. In all but one case, no loss of achieved correction in the foot was found. In one case, the calcaneocuboid joint had to undergo arthrodesis after 5 months because of painful degenerative joint disease. In the pes planovalgus and abductus deformities occurring in stage II disease, calcaneal osteotomy and reconstruction of the medial tendon and ligament seem to play a significant role in operative management. This was the case only when degenerative joint disease and significant subluxation of the subtalar or talonavicular joint or both had not already occurred. They seem to function by restoring more normal biomechanics, which allows reconstructed or transferred tendon to function successfully.     

Halo-股骨髁上牵引对重度脊柱侧凸后路矫形的影响

目的探讨Halo-股骨髁上牵引对重度先天性脊柱侧凸及特发性脊柱侧凸患者后路矫形效果的影响。方法选取60例重度脊柱侧凸患者分为先天性脊柱侧凸组及特发性脊柱侧凸组,每组30例。CS组术前平均冠状面Cobb角、胸椎后凸分别为95．7°及70．2°。IS患者术前平均冠状面Cobb角、胸椎后凸为91．6°及50．6°。平均随访38个月。结果60例患者平均牵引23d,平均牵引重量16kg。IS组患者Halo牵引及后路矫形术后侧凸矫正率分别达39．3％、57．5％,胸椎后凸平均矫正33．7％。CS组Halo牵引及后路矫形术后侧凸矫正率分别达35．3％、45．2％,胸椎后凸平均矫正43．5％。两组患者后路矫形术后侧凸及后凸矫正率差异均有统计学意义（P〈0．05）。4例患者在牵引过程中并发臂丛神经麻痹,神经功能均在2个月内获得完全恢复。结论Halo-股骨髁上牵引可大幅提高脊柱侧凸尤其是特发性脊柱侧凸畸形矫正疗效。