组合可调式Halo-骨盆固定支具的设计及初步临床应用

目的设计新型组合可调式Halo-骨盆固定支具并观察该装置联合截骨术治疗重度僵硬型脊柱畸形的临床疗效。方法回顾性分析2015年2月—2017年6月采用Halo-骨盆固定支具术前牵引联合截骨术治疗的8例重度僵硬型脊柱畸形(特发性侧凸7例,结核性后凸1例)患者的临床资料。记录并观测患者治疗前后脊柱侧凸/后凸Cobb角、躯干偏移距离、躯干高度(T_1～S_1)及身高的改善程度。结果 8例患者均顺利完成手术。7例特发性侧凸患者牵引后及术后Cobb角、躯干高度(T_1～S_1)、躯干偏移距离及身高均较术前显著改善,差异有统计学意义(P 0.05);牵引后及术后Cobb角矫正率分别为29.3%、46.8%。1例结核性后凸患者,牵引后及术后后凸Cobb角及身高均较术前显著改善,牵引后及术后后凸Cobb角矫正率分别为4.9%、34.0%。牵引过程中2例发生盆针皮肤切割伴感染,1例发生颅钉松动脱落,均经对症治疗后痊愈。结论组合可调式Halo-骨盆固定支具可满足重度僵硬型脊柱畸形患者术前脊柱固定和牵引的治疗需求,通过术前缓慢牵引可逐步矫正重度脊柱畸形,是一种简便、安全、有效的辅助治疗手段。

Design and preliminary clinical application of combined adjustable Halo-pelvic fxation brace

Objective To design a new type of adjustable Halo-pelvic fixation brace and observe the clinical effect of the device in combination with osteotomy in the treatment of severe rigid spinal deformity.Methods From February 2015 to June 2017, the clinical data of 8 patients with severe rigid spinal deformity(idiopathic scoliosis in 7 cases, tuberculous kyphosis in 1 case) treated with preoperative Halo-pelvic fixation brace traction combined with osteotomy were analyzed retrospectively. The improvement of scoliosis/kyphosis Cobb''s angle, trunk offset distance, trunk height(T₁-S₁) and body height were observed and recorded before and after treatment.Results All the patients completed the operation successfully. The Cobb''s angle, trunk height(T₁-S₁), trunk offset distance and body height of 7 idiopathic scoliosis patients were significantly improved at post-traction and post-operation; compared with pre-operation, the differences were statistically significant(P < 0.05). The correction rate of Cobb''s angle at post-traction and post-operation was 29.3% and 46.8%, respectively. The Cobb''s angle and height of the patient with tuberculous kyphosis were significantly improved at post-traction and post-operation; the correction rate of Cobb''s angle at post-traction and post-operation was 4.9% and 34.0%, respectively. During the process of traction, there were 2 patients with pelvic needle skin incision with infection and 1 patient with loose and fallen cranial nail, all of whom have been healed after symptomatic treatment.Conclusion Combined adjustable Halo-pelvic fixation brace can meet the treatment needs of preoperative spine fixation and traction for patients with severe rigid spinal deformity. Severe rigid spinal deformity can be gradually corrected by slow preoperative traction, therefore it is a kind of assistant treatment way with simpleness, safety and effectiveness.