大重量Halo-股骨髁上牵引在治疗重度僵硬性特发性脊柱侧凸中的矫形贡献率分析

Analysis of the rate of orthopaedic contribution of strong halo-femoral traction in the treatment of severe rigid idiopathic scoliosis

目的 探讨大重量Halo-股骨髁上牵引在治疗重度僵硬性特发性脊柱侧凸中的矫形贡献率及其临床价值.方法 回顾性分析2008年12月至2010年8月采用大重量Halo-股骨髁上牵引的27例重度僵硬性特发性脊柱侧凸患者的病历资料,术前均采用湘雅阶梯渐进式Halo-双侧股骨髁上牵引2～4周,术中维持牵引下行一期后路松解内固定矫形植骨融合术.通过测量术前全长站立正位、仰卧位Bending像、支点加压位、牵引后及术后X线片的侧凸Cobb角,对各矫形要素（即Bending、支点加压、牵引、手术）的绝对和相对贡献率进行统计学分析.结果 27例患者随访时间为40～68个月,平均（51.8±7.7）个月.术前主弯Cobb角平均105.1°±11.1°（88°～131°）,Bending像平均为84.6°±12.6°（69°～115°）,支点加压位平均为75.8°±10.5°（62°～97°）,牵引后平均为66°±11.7°（50°～90°）,术后平均为43.1°±8.8°（23°～58.1°）.牵引后矫正率平均为37.5％±6.4％（28.6％～54％）,最终矫正率为57.2％±6.7％（51.5％～67.7％）.Bending的绝对及相对贡献率平均为19.8％±4.4％（12.2％～28.1％）、33.8％±7.6％ （21.4％～46.2％）;支点加压的绝对及相对贡献率平均为8.2％±4.3％（2.9％～24.8％）、13.3％±6.9％（1.1％～35.5％）;牵引的绝对及相对贡献率平均为9.5％±4.7％（2％～20％）、16.2％±8.2％（3.4％～36.5％）;手术的绝对及相对贡献率平均为21.7％±7.0％（5.9％～37.2％）、36.7％±10.7％（1 1.6％～55.6％）.牵引过程中有1例患者出现右手小指麻木、2例患者出现膝、髋关节僵硬,未出现钉道松动、感染等其他并发症,术中及术后均无瘫痪、呼吸衰竭及死亡等并发症,随访期间无断钉、断棒现象发生.结论 重度僵硬型特发性脊柱侧凸的治疗中采用湘雅阶梯渐进式大重量Halo-股骨髁上牵引,其矫形贡献率相对突出,同时使矫形风险分散,可有效地避免很多不必要的VCR截骨矫形术,降低了手术风险,是治疗重度僵硬型特发性脊柱侧凸的一种安全、有效的方法.

Objective To analyze the rate of orthopaedic contribution of strong halo-femoral traction in the treatment of severe rigid idiopathic scoliosis and discuss its meaning.Methods All of 27 cases of severe rigid idiopathic scoliosis patients treated with strong halo-femoral traction,hospitalized in our department from December 2008 to August 2010,were retrospectively analyzed.All patients underwent preoperative Halo-femoral traction.After 2-4 weeks＆#39; traction,one-stage posterior instrumentation and fusion was performed with intraoperative traction.The Cobb angles in coronal plane of the major curve before surgery,on bending film,on fulcrum film,after traction and immediately after surgery were measured.The rate of absolute and relative contribution of every orthopaedic element （Bending,fulcrum,traction,surgery） were compared.Results The duration of follow-up was （51.8±7.7） months on average （range,40-68 months）.The mean coronal Cobb angle of major curve were 105.1°±11.1°（88°-131°）,the mean coronal Cobb angle of major curve on Bending film were 84.6°±12.6°（69°-115°）,and the mean coronal Cobb angle of major curve on fulcrum film were 75.8°10.5°（62°-97°）.The mean coronal Cobb angle of major curve after traction were 66°±11.7° （50°-90°）.The mean coronal Cobb angle of major curve after posterior surgery were 43.1°±8.8°（23°-58.1°）.The mean correction rate after traction was 37.5%±6.4% （28.6%-54%）,the correction rate after surgery was 57.2%±6.7% （51.5%-67.7%） on the average.The rate of absolute and relative contribution of Bending were 19.8%±4.4% （12.2%-28.1%）、33.8%±7.6% （21.4%-46.2%）.The rate of absolute and relative contribution of fulcrum were 8.2%±4.3% （2.9%-24.8%）、13.3%±6.9%（1.1%-35.5%）.The rate of absolute and relative contribution of traction were 9.5%±4.7% （2%-20%）、16.2%±8.2% （3.4%-36.5%）.The rate of absolute and relative contribution of surgery were 21.7%±7.0%（5.9%-37.2%）、36.7%± 10.7% （11.6%-55.6%）.In the process of traction one patient had the right little finger numb and two other patients experienced stiff knee and hip,there were no other related complications occurring in the process of traction.No death or respiratory failure or paralysis occurred intra-and post-operatively.No screw or rod fracture was found during the follow-up.Conclusion The study indicates that the XiangYa gradual strong halo-femoral traction makes relatively prominent role in the treatment of severe rigid idiopathic scoliosis,meanwhile makes the correction diversification,reduces the risk of operation,effectively avoids many unnecessary VCR,and is a safe and effective way for the treatment of severe rigid idiopathic scoliosis.