Halo重力牵引辅助治疗重度先天性脊柱侧弯的临床研究

Efficacy of halo gravity traction for severe congenital scoliosis

目的评估术前Halo重力牵引(halo gravity traction,HGT)辅助治疗重度先天性脊柱侧弯(congenital scoliosis,CS)的临床效果。方法回顾性分析2016年10月至2021年12月首都医科大学附属北京儿童医院骨科收治的55例重度脊柱侧弯患儿临床资料,其中男28例,女27例,年龄(9.4±3.8)岁。根据病因分为先天性脊柱侧弯组(28例)和非先天性脊柱侧弯组(27例)。两组均接受HGT治疗。收集两组牵引前、牵引后及术后站立位全脊柱正侧位X线片,测量主弯、代偿弯、胸椎后凸、腰椎前凸、冠状面及矢状面躯干平衡、肩高度、T1-S1高度,评估两组患儿畸形矫正情况及治疗效果差异。结果先天性脊柱侧弯组和非先天性脊柱侧弯组术前主弯Cobb角分别为(88.9±14.1)°和(89.5±17.4)°;代偿弯Cobb角分别为(28.8±12.9)°和(33.3±12.9)°;胸椎后凸分别为(74.1±21.0)°和(69.9±20.8)°;腰椎前凸分别为(47.9±13.4)°和(38.9±6.6)°;冠状面躯干平衡分别为(43.2±15.5)mm和(38.3±10.2)mm;矢状面躯干平衡分别为(34.7±10.5)mm和(44.4±19.8)mm;肩高度分别为(22.8±11.8)mm和(13.9±12.1)mm;T1-S1高度分别为(24.3±5.4)cm和(27.2±5.2)cm。接受HGT治疗后,先天性脊柱侧弯组和非先天性脊柱侧弯组主弯Cobb角分别为(64.2±14.6)°和(53.0±14.9)°;代偿弯Cobb角分别为(16.5±10.3)°和(19.2±11.0)°;胸椎后凸分别为(53.7±16.9)°和(48.3±14.4)°;腰椎前凸分别为(37.4±7.0)°和(30.2±8.0)°;冠状面躯干平衡分别为(24.6±12.0)mm和(20.3±11.6)mm;矢状面躯干平衡分别为(30.7±2.9)mm和(19.1±11.6)mm;肩高度分别为(12.0±7.1)mm和(7.0±4.0)mm;T1-S1高度分别为(28.1±5.0)cm和(31.5±5.0)cm;较牵引前均明显改善(均P<0.01)。但两组比较,非先天性脊柱侧弯组主弯矫正率(41.3±8.7)%高于先天性脊柱侧弯组(27.4±10.9)%,差异有统计学意义(P<0.01),其他参数差异无统计学意义(P>0.05)。手术后,先天性脊柱侧弯组和非先天性脊柱侧弯组主弯Cobb角分别为(41.7±13.9)°和(37.4±12.8)°;胸椎后凸分别为(40.5±16.3)°和(38.4±8.9)°;腰椎前凸分别为(33.4±6.2)°和(25.9±7.9)°;冠状面躯干平衡分别为(19.4±8.2)mm和(19.1±6.0)mm;矢状面躯干平衡分别为(18.6±11.2)mm和(20.3±11.4)mm;肩高度分别为(11.5±7.1)mm和(9.0±5.6)mm;T1-S1高度分别为(30.2±5.4)cm和(32.5±7.1)cm;均较术前均明显改善(P<0.01);但两组之间改善程度比较差异无统计学意义(P>0.05)。结论HGT治疗重度CS可以在术前矫正结构侧弯及代偿侧弯,纠正冠状面及矢状面躯干偏移。虽然CS主弯矫正率低于非CS,但经过HGT再行手术治疗可以达到相同的最终矫正效果。

Objective To evaluate the efficacy of preoperative halo gravity traction(HGT)assisted surgery for severe congenital scoliosis(CS).Methods From October 2016 to December 2021,clinical data were retrospectively reviewed for 55 children with severe scoliosis undergoing HGT.There were 28 boys and 27 girls with an average age of(9.4±3.8)years.According to etiology,they were divided into two groups of congenital(n=28)and non-congenital(n=27).At pre-operation,post-traction and post-operation,radiographic films of whole spine in standing position was employed for measuring main curve,compensatory curve,thoracic kyphosis and lumbar lordosis,trunk balance in coronal and sagittal planes,shoulder height and T1-S1 height and evaluate the improvement of deformity.And the differential efficacy was examined between two groups.Results Cobb angle of major bend pre-operation in congenital and non-congenital groups was(88.9±14.1)°and(89.5±17.4)°;Cobb angle of compensatory bending(28.8±12.9)°and(33.3±12.9)°;thoracic kyphosis(74.1±21.0)°and(69.9±20.8)°;lumbar lordosis(47.9±13.4)°and(38.9±6.6)°;trunk balance in coronal plane(43.2±15.5)and(38.3±10.2)mm;sagittal torso balance(34.7±10.5)and(44.4±19.8)mm;shoulder height(22.8±11.8)and(13.9±12.1)mm;height of T1-S1(24.3±5.4)and(27.2±5.2)cm.The above findings have demonstrated that after HGT,Cobb angle of major curvature in congenital and non-congenital groups were(64.2±14.6)°and(53.0±14.9)°;Cobb angle of compensated bending(16.5±10.3)°and(19.2±11.0)°;hosthoracic kypis(53.7±16.9)°and(48.3±14.4)°;lumbar lordosis(37.4±7.0)°and(30.2±8.0)°;trunk balance in coronal plane(24.6±12.0)and(20.3±11.6)mm;sagittal torso balance(30.7±2.9)and(19.1±11.6)mm;shoulder height(12.0±7.1)and(7.0±4.0)mm;T1-S1 height(28.1±5.0)and(31.5±5.0)cm;there were significant improvements as compared with those pre-traction(P<0.01).The correction rate of major curve in non-congenital group(41.3±8.7)%was significantly higher than that in congenital group(27.4±10.9)%after HGT(P<0.01)and no differences existed in other parameters between two groups(P>0.05).After operation,Cobb angle of major curvature in congenital and non-congenital groups were(41.7±13.9)°and(37.4±12.8)°;thoracic kyphosis(40.5±16.3)°and(38.4±8.9)°;lumbar lordosis(33.4±6.2)°and(25.9±7.9)°;trunk balance in coronal plane(19.4±8.2)and(19.1±6.0)mm;sagittal torso balance(18.6±11.2)and(20.3±11.4)mm;shoulder height(11.5±7.1)and(9.0±5.6)mm;height of T1-S1(30.2±5.4)and(32.5±7.1)cm;there were significant improvements as compared with those pre-operation(P<0.01).However,there was no inter-group difference(P>0.05).Conclusion HGT for severe CS can correct structural scoliosis and compensatory scoliosis pre-operation,and correct trunk deviation in coronal and sagittal planes.Although the correction rate of CS is lower than that of non-CS,the final correction efficacy can be the same after HGT surgery.