自制髂骨穿针导向器在重度脊柱侧弯颅盆环牵引中的应用

Application of self-made iliac puncture guide in severe and rigid scoliosis with Halo pelvic traction

目的评价自制髂骨穿针导向器在重度脊柱侧弯颅盆环牵引中的准确性及安全性。方法纳入2015年1月至2021年5月行颅盆环牵引的脊柱侧弯患者共22例,男9例,女13例;年龄14~28岁,平均17.6岁;cobb角90°~140°,平均108.8°。根据髂骨穿针手术方式不同分为导向器组和徒手组,导向器组共10例,采用自制髂骨穿针导向器进行髂骨穿针;徒手组共12例,采用徒手髂骨穿针。每例患者两侧髂骨各置入1枚髂骨针,本研究总穿针数为44枚。比较两组患者术中穿刺次数、偏离距离、手术时间、软组织损伤程度、术后住院时间及并发症情况。结果两组患者年龄、性别、体质量、cobb角等一般资料差异无统计学意义。导向器组平均穿刺次数为(2.50±0.55)次、偏移距离为(0.50±0.07)cm、手术时间为(30.50±4.46)min、软组织损伤为(1.83±0.75)级、术后住院时间为(4.33±0.82)d;徒手组平均穿刺次数为(4.00±0.76)次、偏移距离为(2.30±1.20)cm、手术时间为(60.13±26.35)min、软组织损伤为(3.38±1.19)级、术后住院时间为(8.88±3.14)d。导向器组2例针道感染;徒手组2例针道感染,2例皮肤坏死,神经、血管损伤各1例。结论自制髂骨穿针导向器在重度脊柱侧弯颅盆环牵引中,能够减少穿刺次数、偏移距离、缩短手术时间及术后住院时间,减少并发症。

Objective To evaluate the accuracy and safety of self-made iliac puncture guide in severe and rigid scoliosis(SRS)with Halo pelvic traction.Methods From January 2015 to May 2021,22 patients with SRS were treated by the Halo pelvic traction.There were 9 males and 13 females,aged 14 to 28 years with an average of 17.6 years;cobb angle was 90°to 140°with an average of(108.80±13.42)°.According to the different methods of iliac puncture,they were divided into guide group(10 patients)in which the self-made guide device was used for iliac puncture and unarmed group(12 patients)in which the needle was punctured through the iliac bone with bare hands.One iliac needle was inserted into each iliac bone of each patient,and the total number of needles in this study was 44.The puncture times,deviation distance,operation time,degree of soft tissue injury,postoperative hospital stay and complications were compared and analyzed.Results There was no significant difference in age,gender,body mass,or cobb angle between the two groups.In the guide group the average puncture times was(2.50±0.55),the offset distance was(0.50±0.07)cm,the operation time was(30.50±4.46)min,soft tissue injury was grade(1.83±0.75),and postoperative hospital stay was(4.33±0.82)d.In the unarmed group the average puncture times was(4.00±0.76),the offset distance was(2.30±1.20)cm,the operation time was(60.13±26.35)min,soft tissue injury was grade(3.38±1.19),and postoperative hospital stay was(8.88±3.14)d.There were 2 cases of needle tract infection in both groups respectively.In the unarmed group,there were 2 cases of skin necrosis and 1 case of neurovascular injury.Conclusion The self-made iliac puncture guide in SRS with Halo pelvic traction can reduce the number of punctures,offset distance,shorten operation time,postoperative hospital stay and complications.