悬吊牵引预矫形手术融合内固定治疗青少年颈椎严重角状后凸畸形

Effect of cervical suspensory traction combined with instrumentation and fusion surgery on the treatment of severe cervical kyphotic deformity in teenagers

目的:探讨颈椎悬吊牵引预矫形结合手术融合内固定治疗青少年颈椎严重角状后凸畸形的效果。方法:4例青少年严重颈椎角状后凸畸形患者,男3例,女1例,年龄13～18岁,平均16岁;颈椎后凸角45°～125°,平均85.3°;所有病例均先行颈椎悬吊牵引7～21d,再行矫形内固定融合手术。结果:在颈椎悬吊牵引过程中无并发症发生,悬吊牵引预矫形度数平均为66.7°,预矫形率平均68%;手术后矫形至平均后凸17°,平均矫形度数68.3°,平均矫形率80%。悬吊牵引对总矫形效果的贡献率为86%;手术矫形角度平均为-3°,手术矫形率为-2%,手术对总矫形效果的贡献率为-4%;颈椎自身活动度为13.3°,对总矫形效果的贡献率为18%。3例有慢性脊髓病症状者其不全瘫症状均有改善。3例在3个月￣1年随访时神经功能全部正常,固定融合节段的后凸角均无变化;1例失访。结论:颈椎悬吊牵引治疗过程安全、方便,患者易于耐受,结合手术融合内固定对于青少年颈椎严重角状后凸畸形有良好的矫形效果。

Objective：To evaluate the effect of cervical suspensory traction combined with instrumentation and fusion surgery on treating the severe cervical kyphotic deformity in teenagers.Method：Four teenage cases with severe cervical kyphotic deformity were treated.The average age was 16 years （range,from 13 to 18 years） ,there were three male and one female.The mean kyphotic angle was 85.3^o（range,from 45^o to 125^o）.A11 patients underwent cervical suspensory traction pre-correction for a period of 7 to 21 days in advance, subsequently,instrumentation and fusion surgery were performed.Result：No any complication occured during the cervical suspensory traction.For the pre-correction effect of cervical suspensory traction,the main rate and degree of kyphosis pre-correction was 68% and 66.7^o respectively.After surgery,the deformity was corrected to 17^o averagely,the average corrected degree and rate was 68.3^o and 80% respectively.The contribution rate of cervical suspensory traction to the total correction was 86%,however,average correction degree in the surgery was -3^o ,the average correction rate in the surgery was -2% and the contribution rate of surgery was -4%. The average motion range of cervical spine before treatment was 13.3^o ,whose contribution rate to the total correction was 18%.The myelopathy symptoms were improved after treatment in three cases.At 3 months to 1 year follow up in three cases,the neurologic recoveried to normal and the kyphosis angles were stable without any deterioration within the levels of correction and fusion.Conclusion：Cervical suspensory traction is a safe, simple method,which can be tolerated by the patients,combing with surgery it can make a better effect of correcting severe cervical kyphosis in teenagers.