牵引结合后路手术治疗重度脊柱侧凸的疗效分析

目的]探讨Halo-股骨髁上牵引结合后路矫形对柔韧性30%～40%的重度脊柱侧凸患者的疗效.方法]对2000年1月～2006年6月治疗的41例柔韧性30%～40%重度脊柱侧凸患者,按照是否行牵引治疗分为两组.牵引组A组 22例,主侧凸平均Cobb' s角91.2°;对照组B组 19例,主侧凸平均Cobb' s角87.5°.结果]两组无严重神经系统并发症.A组平均牵引18 d(14～22 d)后主侧凸平均矫正46%,14例肺功能减退患者均改善.两组均行一期后路松解三维矫形术,术后C7～S1偏移值、顶椎偏移矫正A组优于B组.A组主侧凸平均矫正55.2°,B组45.7°,A组优于B组 (P<0.05). A组平均随访40个月, B组平均随访42个月,末次随访两组平均冠状面矫正丢失分别为3°、2.4°,矢状面无丢失,两组均获骨性融合.结论]对于柔韧性30%～40%的重度脊柱侧凸,术前Halo-股骨髁上牵引可改善肺功能,结合牵引下后路松解矫形术可以获得更好的畸形矫正和躯干平衡,减少术中术后并发症. )后主侧凸平均矫正46%,14例肺功能减退患者均改善.两组均行一期后路松解三维矫形术,术后C_7～S_1偏移值、顶椎偏 矫正A组优于B组.A组主侧凸平均矫正55.2°,B组45.7°,A组优于B组 (P<0.05). A组平均随访40个月, B组平均随访42个月,末次随访两组平均冠状面矫正丢失分别为3°、2.4°,矢状面无丢失,两组均获骨性融合.结论]对于柔韧性30%～40%的重度脊柱侧凸,术前Halo-股骨髁上牵引可改善肺功能,结合牵引下后路松解矫形术可以获得更好的畸形矫正和躯干平衡,减少术中术后并发症. )后主侧凸平均矫正46%,14例肺功能减退患者均改善.两组均行一期后路松解三

Effect of halo-femoral traction and posterior correction for severe scoliosis

Objective] To discuss the efficacy of Halo - femoral traction combined with posterior surgery for idiopathic scoliosis. Methods] A total of 41 patients with severe idiopathic scoliosis (flexibility of 30%～40% ) from Jan. 2000 to Jun. 2006 were retrospectively reviewed. The patients were devided into 2 groups according to whether preoprative traction was used (n1 =22, n2 = 19 respectively) . The average preoperative Cobb's angle was 91.2° in group A and 87.5° in group B. Results] No severe neural complications were noted in both groups. Traction was used in group A for an average of 18 days before spinal fusion ( range, 14～22 days) . After traction , the patients in group A achieved a mean correction of 46% , and 14 of them with pulmonary function compromise got respiratory function improved . All 41 patients underwent posterior extensive release and correction . Shorter operative time and better C_7PL-CSVL distance and AVT (apical vertebra translation) corretion were achieved in group A. The major coronal curve was reduced by 55.2 °and 45.7° after posterior spinal fusion, respectively. The average loss of correction was 3 for major coronal curves at an average of 40 - month follow - up in group A, and 2.4° at an average of 42 - month follow - up in group B. All cases got solid bony fusion. Conclusion] Perioperative halo - femoral traction can improve pulmonary function and reduce operative complications of severe scoliosis with flexibility of 30% or 40%. Better deformity correction and trunk balance can be achieved by traction as an adjunct to posterior extensive release and correction.