大重量Halo-股骨髁上牵引在重度僵硬性非特发性脊柱侧凸矫形中贡献率的分析

Corrective contribution of strong halo-femoral traction in the treatment of severe rigid nonidiopathic scoliosis

[目的]分析大重量Halo-股骨髁上牵引在治疗重度僵硬性非特发性脊柱侧凸中的矫形贡献率及临床意义。[方法]对2008年12月~2011年8月在本科住院并采用湘雅阶梯渐进式大重量Halo-股骨髁上牵引的26例重度僵硬性非特发性脊柱侧凸患者进行回顾性分析。所有病例术前均行Halo-双侧股骨髁上牵引,牵引2~4周后,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、术后侧凸Cobb角,对各矫形要素(Bending、支点加压、牵引、手术)绝对和相对贡献率进行统计学分析。[结果]牵引过程中未出现钉道松动、感染等并发症,术中及术后均无瘫痪、呼吸衰竭及死亡等并发症,随访时间为(42~70)个月,平均为54.00个月;随访期间无断钉、断棒等现象发生。术前站立位主弯侧凸Cobb角平均93.00°±18.90°(71.00°~121.00°),仰卧位Bending像平均为74.70°±20.04°(52.50°~106.00°),支点加压位平均为68.90°±18.21°(48.00°~96.60°),牵引后平均为59.80°±15.82°(42.00°~79.80°),术后平均为40.60°±12.09°(23.00°~58.10°);各矫形要素(Bending、支点加压、牵引、手术)的绝对贡献率为20.50%±6.02%、6.22%±3.29%、9.63%±5.42%、20.58%±8.61%,总贡献率为56.83%±6.87%(51.50%~67.61%)。2例患者牵引过程中出现背部后凸处皮肤压红,5例出现不同程度膝、髋关节僵硬。[结论]在重度僵硬性非特发性脊柱侧凸治疗中,采用湘雅阶梯渐进式大重量Halo-股骨髁上牵引,矫形贡献率相对突出,可有效地使矫形风险分散,降低手术风险,是治疗重度僵硬型非特发性脊柱侧凸一种安全、有效的方法。

[Objective] To analyze the rate of corrective contribution of strong halo-femoral traction in the treatment of severe rigid nonidiopathic scoliosis and discuss its meaning. [Methods] Twenty-six patient with severe rigid nonidiopathic scoliosis treated with preoperative strong halo-femoral traction, hospitalized in our department from December 2008 to August 2011, were retrospectively analyzed. After 2-4weeks＇ 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 corrective element （bending, fulcrum, traction, surgery） were compared. [Results] The duration of follow-up was 54.00 months on average （range, 42-70 months） . 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. The mean coronal Cobb angle of major curve were 93.00°± 18.90° （71.00°- 121.00° ） , the mean coronal Cobb angle of major curve on Bending film were 74.70 °±20.04° （52.50°- 106.00° ） ,and the mean coronal Cobb angle of major curve on fulcrum film were 68.90 °±18.21° （48.000-96.60°） .The mean coronal Cobb angle of major curve after traction were 59.80°± 15.82° （42.00°-79.80° ） ,The mean coronal Cobb angle of major curve after posterior surgery were 40.60°± 12.09° （23.00°-58.10° ） .The rate of absolute contribution of every corrective element （Bending, fulcrum, traction, surgery） and the rate of total eontribution were 20.50% ±6.02%,6.22%±3.29%,9.63%±5.42%, 20.58%±8.61% and 56.83%±6.87%. There were two patients occurring redness of skin in the ar- i ea of kyphosis and five patients showing knee and hip stiffness in different degrees. [Conclusion] XiangYa gradual strong halo-femoral traction makes relatively significant role in the treatment of severe rigid nonidiopathie scoliosis, meanwhile decreases the risk of operation, and is a safe and effective method for the treatment of severe rigid nonidiopathic scoliosis.