Halo-股骨髁上牵引一期后路手术治疗先天性脊髓纵裂脊柱侧凸

One-stage posterior surgical correction secondary to a big-weight halo-femoral traction for rigid congenital scoliosis accompanied with split cord malformation

[目的]探讨大重量halo-股骨髁上牵引辅助一期后路手术治疗伴脊髓纵裂的僵硬型先天性脊柱侧凸的安全性和临床疗效。[方法]回顾性研究2011～2016年本科收治的伴脊髓纵裂的僵硬型先天性脊柱侧凸患者18例,年龄10～24岁,平均(16.33±4.61)岁;主弯位于胸段9例,胸腰段2例,腰段7例;其中分节不良10例,形成障碍2例,混合型6例;合并I型脊髓纵裂4例,II型脊髓纵裂12例,复合型2例。术前主弯冠状面Cobb角60°～113°,平均(81.28±16.25)°;凸侧侧向弯曲位Cobb角44.50°～98.00°,平均(70.31±19.35)°;柔韧性5.85%～28.66%,平均15.81%;所有患者术前均未发现神经功能异常。均采用术前大重量halo-股骨髁上牵引辅助一期后路矫形手术。[结果]手术时间240～380 min,平均(327.78±44.10) min;术中出血量640～2 100 ml,平均(1 285.56±523.52) ml。随访12～36个月,平均(20.44±8.29)个月。大重量牵引后主弯冠状面Cobb角减少至35.60°～87.50°,平均(56.38±16.35)°;后路矫形术后主弯冠状面Cobb角减少至19.10°～56.20°,平均(35.92±13.74)°;侧凸矫正率为48.19%～69.40%,平均(60.24±9.04)%;末次随访时主弯冠状面Cobb角19.50°～57.10°,平均(36.36±13.42)°,与矫形术后相比无明显丢失。术中、术后及随访时均未出现神经功能损伤表现。[结论]大重量halo-股骨髁上牵引辅助一期后路手术治疗伴脊髓纵裂的僵硬型先天性脊柱侧凸,在不切除纵隔和脊柱缩短截骨的情况下,可获得较满意的矫形效果和安全性。

[Objective] To explore the safety and clinical outcomes of one-stage posterior surgical correction secondary to a big-weight halo-femoral traction for rigid congenital scoliosis(CS) accompanied with split cord malformation(SCM). [Methods] A retrospective study was conducted on 18 patients who underwent one-stage surgical correction for rigid CS with SCM from 2011 to 2016. The patients, 5 males and 13 females aged from 10 to 24 years with an average of(16.33±4.61) years, had the main curve at the thoracic in 9 cases, the thoracolumbar in 2 and the lumbar in 7, which were consisted of failure of vertebral segmentation in 10 cases, failure of vertebral formation in 2 and mixture malformation in 6, accompanied with SCM type I in 4 cases, type II in 12 and combined type in 2 cases. The preoperative coronal Cobb angle of main curve ranged from 60° to113° with a mean of(81.28±16.25)°, while the Cobb angle varied from 44.50° to 98.00° with an average of(70.31±19.35)° on bending radiographs, associated with flexibility ranged from 5.85% to 28.66% and 15.81% on average. No obvious neural dysfunction was found in anyone of the patients before treatment. All the patients had surgery performed after a bigweight halo-femoral traction. [Results] The surgical operation lasted for an average of(327.78±44.10) mins(range, 240 to 380 mins) with associated with intraoperative blood loss of(1 285.56± 523.52) ml on average(range, 640 to 2100 ml).The patients were followed up for an average of(20.44±8.29)months(range, 12 to 36 months). The coronal Cobb angle of main curve significantly decreased to(56.38±16.35)°(range, 35.60°~87.50°) after big-weight halo-femoral traction compared with that before treatment(P<0.05), which further significantly decreased to(35.92±13.74)°(range, 19.10°~56.20°) after onestage posterior surgical correction(P<0.05), associated with postoperative correction rate of(60.24±9.04)%(range, 48.19%~69.40%). At the latest follow up, the coronal Cobb angle of main curve proved(36.36±13.42)°(range, 19.50°~57.10°), without obvious correction loss compared with the Cobb angle immediately postoperatively(P>0.05). No nerve function impairments were noticed in any patient during the whole course of treatment and follow up. [Conclusion] Without dealing with SCM or vertebral column subtraction osteotomy, the one-stage posterior surgical correction secondary to a big-weight halo-femoral traction for rigid CS with SCM is safe and satisfactory in clinical outcomes