头盆环牵引、软组织松解在极重度脊柱畸形矫形中的应用

Orthopedics in the Most Serious Spine Deformity by Halo-Pelvic Traction, Soft Tissue Release

[目的]:观察头盆环在极重度脊柱畸形患者的治疗过程中的安全性及有效性。[方法]:2011年9月~2012年6月住院患者7例,其中脊柱结核后凸3例(静止期),青少年特发性脊柱侧凸4例。Cobb’s角在136?~180?,平均(168.8?)。身高在128 cm^145 cm (平均135.4 cm)。截骨矫正前行头盆环牵引。牵引70~213天(平均128.4天)后,行截骨矫正术后30天,观察角度身高及临床症状。[结果]:7例患者全部在头盆环牵引下顺利完成了软组织松解,截骨矫形融合内固定术,脊柱后凸Cobb’s角由治疗前的136?~180? (平均168.8)矫正至0?~42? (平均33.5?),矫正率81%;身高由牵引前的128 cm^145 cm (平均135.4 cm)增高至138~160 cm (平均150.7 cm)患者身高差9~27 cm。患者外观、行走姿势均得到明显改善,无脊髓神经损伤等严重并发症发生,2例合并脊髓受压(不全瘫),患者肌力有III~级增至IV级。[结论]:头盆环牵引、软组织松解在治疗极重度脊柱畸形过程中的一种安全有效的方法之一。它可通过缓慢牵引使极重度脊柱畸形变为中、轻度脊柱畸形,这样减小矫正的手术风险,使手术矫正更为安全。

Objective: To observe and evaluate the clinical security and effects of halo-pelvic traction for or-thopedics in the most serious spine deformity. Methods: From September 2011 to June 2012, there are 7 patients, including 3 patients who are diagnosed spinal tuberculosis and 4 patients who are diagnosed adolescent idiopathic scoliosis. The mean Cobb’s is 168.8?, ranging from 136? to 180?. The mean height is 135.4 cm, ranging from 128 to 145 cm. Before osteotomy, everyone is pulled by halo-pelvic traction. The mean pulling is 128.4 days, ranging from 70 to 213 days, after osteotomy, observing the Cobb’s, height and the clinical symptoms in 30 days. Results: all the patients are in safe in the soft tissue lysis, osteotomy and fusion internal fixation after pulling by halo-pelvic trac-tion. The mean Cobb’s is 33.5?, ranging from 0? to 42? after operation;the correction rate is 81%. The mean height is 150.7 cm, ranging from 138 to 160 cm after operation. The height difference of the patience is 9 cm to 27 cm. The physical appearance and walking of the patients are improved. No complications such as spinal cord injury occurred. In two of them, the muscle tone, which was under the MRC grade 3 motor because of spinal cord compressed severed before operation, achieved the MRC grade 4 motor after operation. Conclusion: Halo-pelvic traction is the one of se-curity and effect methods in treating the most serious spine deformity. Through slowly traction, the most serious spine deformity can be changed into serious spine deformity or little serious spine deformity, which reduces the risk of orthopedics and is safe in operation.