Halo-股骨髁上牵引对重度脊柱侧凸后路矫形的影响

Effectiveness of halo-femoral traction after posterior spinal release in severe and rigid scoliosis

目的探讨 Halo-股骨髁上牵引对重度先天性脊柱侧凸及特发性脊柱侧凸患者后路矫形效果的影响。方法选取60例重度脊柱侧凸患者分为先天性脊柱侧凸组及特发性脊柱侧凸组,每组30例。CS 组术前平均冠状面 Cobb 角、胸椎后凸分别为95.7°及70.2°。IS 患者术前平均冠状面Cobb 角、胸椎后凸为91.6°及50.6°。平均随访38个月。结果 60例患者平均牵引23 d,平均牵引重量16 kg。IS 组患者 Halo 牵引及后路矫形术后侧凸矫正率分别达39.3%、57.5%,胸椎后凸平均矫正33.7%。CS 组 Halo 牵引及后路矫形术后侧凸矫正率分别达35.3%、45.2%,胸椎后凸平均矫正43.5%。两组患者后路矫形术后侧凸及后凸矫正率差异均有统计学意义(P<0.05)。4例患者在牵引过程中并发臂丛神经麻痹,神经功能均在2个月内获得完全恢复。结论 Halo-股骨髁上牵引可大幅提高脊柱侧凸尤其是特发性脊柱侧凸畸形矫正疗效。

Objective To assess the effectiveness of Halo-femoral traction after posterior spinal release in the management of Congenital Scoliosis （CS） and Idiopathic Scoliosis （IS）. Methods Sixty consecutive patients with severe and rigid scoliosis treated with anterior spinal release and halo-femoral traction were recruited for this retrospective study. CS group included 30 patients （20 females and 10 males） and IS group has 30 patients（23 females and 7 males）. The average coronal Cobb angle of the main curve before operation was 95. 7° in CS and 91.6 °in IS. The mean thoracic kyphosis was 70. 2° in CS and 50. 6° in IS. The average period of followed up was 38 months （range 12 -72 months）. Results The average traction time was 23 days and weight was 16 kg. The mean Cobb angle correction rate after operation was 57.5% in IS and 45. 2% in CS. The correction rate of coronal Cobb angle and kyphosis between IS and CS was statistically significant （ t = - 2. 59, P 〈 0.05 ）. Four patients experienced brachial plexus palsy and complete nerve functional restoration was achieved at two months follow-up. Conclusions Halo-femoral traction was a safe, well-tolerated and effective method for the treatment of severe and rigid scoliosis patients.