改良Halo-骨盆架在儿童重度脊柱侧凸牵引治疗中的应用价值

目的探讨改良Halo-骨盆架在儿童重度僵硬性脊柱侧凸矫形前牵引治疗中的应用价值。方法2006年1月-2011年3月儿童重度僵硬性脊柱侧凸病例18例，在矫形术前用改良Halo-骨盆架进行牵引并对其临床资料进行回顾性分析。术前冠状面侧凸Cobb角82°～159°，平均118．4°，矢状面后凸Cobb角46°～116°，平均91°。最大牵引力为体重的1／3—1／2进行术前牵引。对牵引前、牵引后、矫形术后的侧后凸纠正率进行统计比较。结果平均最大牵引重量8kg，约占平均体重（14．3kg）的51．2％，牵引2～4周（平均2．3周）。6例患者在牵引2周时出现右侧臂丛神经麻痹，减少牵引力后症状消失。矫形术后无瘫痪、呼吸衰竭和死亡发生。牵引后冠状面侧凸纠正率平均39．6％；矢状面后凸纠正率平均30．7％；肺功能及动脉血气结果明显改善。矫形术后冠状面侧凸矫正率平均为49．2％；矢状面后凸矫正率平均为39．3％。结论术前用改良Halo-骨盆架牵引可明显提高儿童重度僵硬性脊柱侧凸效果并能改善患者肺功能，减少并发症。

The Clinical Value of Preoperative Modified Halo Pelvic Frame in the Treatment of Severe Pediatric Scoliosis

Objective To evaluate the clinical value of preoperative modified Halo pelvic frame in the treatment of severe pediatric scoliosis. Method 11 males and 7 females with a mean age of 7.8 years（4-9 years）, totally 18 patients with severe pediatric scoliosis received modified Halo pelvic frame prior to posterior spine fusion were studied retrospectively from January 2006 to March 2011. The preoperative Cobb angle of coronal major curve and the thoracic kyphosis were 118. 4° （ 82°- 159° ） and 91 °（46°- 116° ） respectively. The maximum traction weight was the 1/3 - 1/2 of the body weight. The correction rate of coronal major curve in supine position was compared before and after modified Halo pelvic frame traction and after surgery respectively. Result Traction was lasted for an average of 2.3 weeks （ 2- 4 weeks）. 8kg was taken as the mean maximum traction weight, which was 51.2% of the average body weight （ 14.3 kg）. Six patients experienced transi- ent brachial plexus palsy two weeks after traction but gradually recovered by decreasing the traction weight. No paralysis, death or respiratory failure occurred after surgery. The increasing correction rate of coronal major curve and thoracic kyphosis after modified Halo pelvic frame was 39.6% and 30.7% respectively. Besides, the pulmonary function and blood gas test improved significantly after Halo traction. The postoperative correction rate of coronal major curve and thoracic kyphosis were 49.2% and 39.3% respectively. Conclusion Preoperative modified Halo pelvic frame followed by posterior instrumentation is effective for pediatric severe scoliosis correct, improvement of pulmonary function and decreasing of the traction related complications.