头环背心在颈椎外科的应用

作者观察了用头环背心治疗多种原因所致颈椎不稳定的应用效果。用头环背心治疗了１０７例颈椎不稳定的病人，病种包括结核、损伤、肿瘤和畸形。病人分为非手术治疗组和融合术组。融合术包括寰枢椎后路融合术、枕颈融合术和下颈椎融合术。各种融合术都在头环背心的固定下施行，不用任何内固定。测量了２３例病人用头环背心固定前后的肺功能。１０７例病人中有８９例获得了随访，平均随访时间２５个月，非手术组的病人在头环背心固定下均恢复了颈椎的稳定性。在３１例行寰枢椎后路融合术的病人中有２９例融合成功（９４％），３６例行枕颈融合术的病人中有３２例达到了骨性愈合（８９％）。用头环背心固定的平均时间是１３３天，最长的４５０天。统计学结果显示：用头环背心固定后病人肺活量的均数与固定前相比差异有非常显著性（Ｐ＜０．０１），固定后肺活量减少约１３％。并发症包括颅钉松动（２４例）、钉孔感染（４例）、复位丢失（４例）、颅钉穿透颅骨内板（３例）、背心下皮肤压疮（１例）。作者认为头环背心对颈椎失稳的病人是一种安全、有效的外固定器材。借助这种装置，部分需行颈椎融合术的病人可以免去内固定，使手术更安全、简便。头环背心可使病人的肺活量减少。

Use of the Halo vest Immobilization in Cervical Spinal Surgery

The efficacy of the halo vest in treatment of many types of cervical spinal instabilities was evaluated.107 patients with cervical spinal instabilites due to tuberculosis,trauma,pathological fractures and deformity were included for this study.The patients were divided into two groups.Group 1 underwent nonoperative treatment and group 2 underwent fusion, including atlanto axial,occipito cervical and lower cervical regions.All of the patients were immobilized by use of the halo vest without any internal fixation.Pulmonary function of 23 patients were measured before and after immobilization.89 of 107 patients were followed up for an average period of 25 months.All the patients who underwent nonoperative treatment regained stability.29 of 31 patients who underwent atlanto axial fusion achieved solid bony union and 32 of 36 patients who underwent occipito cervical fusion achieved solid bony union.The average period for hale vest immobilization was 133 days and the longest was 450 days.Statistics showed that the mean of vital capacity (VC) taken from the patients immobilized with the halo vest was significantly less than those without any orthosis.Complications included pin loosening in 24,pin infection in 4,loss of the reduction in 4,penetration of inner plate of calvaria in 3 and pressure sores in 1 case.The authors believe that the halo vest is a safe and an effective orthosis for patients with cervical spinal instability.By means of the halo vest,a part of cervical spinal arthrodesis can be performed without any internal fixation.The halo vest has an adverse influence on the respiratory function,VC of the patients with the halo vest decreased about 13%.