头盆环牵引联合后路截骨矫形术治疗重度僵硬型脊柱侧后凸的短期临床疗效

The short term clinical efficacy of halo-pelvic traction combined with staged posterior spinal fusion for severe rigid spinal deformity

目的:比较头盆环牵引(HPT)联合后路截骨矫形术(PSF)与单纯PSF治疗重度僵硬型脊柱侧后凸的短期临床疗效。方法:回顾性纳入2017—2020年行HPT联合PSF的重度僵硬型脊柱侧凸患者作为HPT+PSF组(19例),纳入同期行单纯PSF的患者作为PSF组(19例)。比较两组患者脊柱矫形参数及畸形改善率、牵引前后肺功能情况[包括用力肺活量(FVC)、FVC%、第1秒最大呼气量(FEV1)和FEV1%]、围手术期指标、身高变化及并发症发生情况。结果:随访时间为12~20个月,平均(16.4±3.5)个月。牵引前,两组患者冠状位Cobb角、矢状位Cobb角、C7PL-CSVL、SVA比较,差异均无统计学意义(P均>0.05)。术后1年,两组患者脊柱冠状位及矢状位Cobb角较术前减小,差异均有统计学意义(P均<0.05)。牵引后,HPT+PSF组患者FEV1,FEV1%,FVC,FVC%均高于本组牵引前,差异均有统计学意义(P均<0.05)。HPT+PSF组患者平均手术出血量少于PSF组,手术时间短于PSF组,差异均有统计学意义(P均<0.05)。两组患者截骨等级比较,差异有统计学意义(P<0.05)。HPT+PSF组患者手术增加高度低于PSF组,总增加高度大于PSF组,差异均有统计学意义(P均<0.05)。HPT+PSF组患者出现牵引相关并发症6例、手术相关并发症2例,PSF组出现手术相关并发症7例。结论:HPT联合PSF治疗重度僵硬型脊柱侧凸安全有效,通过头盆环牵引可改善患者术前肺功能,在降低手术难度的同时获得较好的畸形改善,但需注意避免牵引相关并发症的发生。

Objective:To explore the short-term clinical efficacy of halo-pelvic traction(HPT) combined with posterior spinal fusion(PSF) versus PSF alone in the treatment of severe rigid scoliosis.Methods:This retrospective study included patients with severe rigid scoliosis treated with either HPT combined with PSF(HPT+PSF group,19 cases) or PSF alone(PSF group,19 cases) from 2017 to 2020.The spinal correction parameters and deformity improvement rate,changes in pulmonary function before and after traction(including forced vital capacity [FVC],FVC%,forced expiratory volume in one second [FEV1],and FEV1%),perioperative indicators,height changes,and complications were compared between the two groups.Results:The follow-up time ranged from 12 to 20 months,with an average of(16.4±3.5) months.Before traction,there were no significant difference between the two groups in the Cobb angle in coronal position,Cobb angle in sagittal position,C7PL-CSVL and SVA(all P>0.05).One year after surgery,the coronal and sagittal Cobb angle decreased in the group,the differences were statistically significant(all P<0.05).After traction,the FEV1,FEV1%,FVC,and FVC% in the HPT+PSF group were significantly greater than those before traction(all P<0.05).The HPT+PSF group had significantly lower average surgical blood loss and operation time compared to the PSF group(all P<0.05).A significant difference was noted in the osteotomy grading between groups(P<0.05).The height increase in the HPT+PSF group was significantly lower than that in the PSF group,and the overall height increase in the HPT+PSF group was significantly higher than that in the PSF group(both P<0.05).There were 6 cases of traction-related complications and 2 cases of surgery-related complications in the HPT+PSF group,compared to7 complications in the PSF group.Conclusions:HPT combined with PSF is safe and effective in the treatment of severe rigid scoliosis.HPT enhances preoperative pulmonary function and facilitates improvement in deformity while reducing surgical complexity.However,attention should be given to the high incidence of traction-related complications.