头-盆环牵引矫正重度僵硬脊柱畸形的意义△

Significance of halo- pelvic traction in correction of severe rigid congenital scoliosis complicated with diastematomyelia

摘要:

［目的］探讨头-盆环牵引对重度僵硬先天性脊柱侧弯伴骨性脊髓纵裂矫正的意义。［方法］回顾性分析 2015 年 8 月 —2020 年 8 月本院脊柱外科分二期手术治疗的 18 例重度僵硬先天性脊柱侧弯伴骨性脊髓纵裂患者的临床资料，所有患者均一期手术安装头-盆环牵引装置，继而持续牵引，再二期手术矫形。分析牵引前后及矫形术后与末次随访临床及影像指标。［结果］ 18 例患者牵引时间平均 （35.22±8.32） d，牵引后身高、体重均较牵引前显著增加 （P<0.05）。18 例患者手术时间平均 （301.71±82.12） min；术中出血量平均 （861.15±462.60） ml。 随访时间 12~36 个月，末次随访时，患者身高、三头肌皮皱及 SRS-22 评分均较术前显著增加（P<0.05），牵引后、矫形术后及末次随访主弯冠状面 Cobb 角、后凸 Cobb 角均较牵引前显著减小（P<0.05）。末次随访时肺功能肺活量、第一秒用力呼气量均较牵引前显著增加（P<0.05），血浆白蛋白浓度较术前显著增加 （P<0.05）。至末次随访时均未出现内固定移位、松动及断裂。［结论］头-盆环牵引矫正重度僵硬先天性脊柱侧弯伴骨性脊髓纵裂是安全有效的治疗手段。

Abstract:

[Objective] To investigate the significance of halo-pelvic traction in correction of severe rigid congenital scoliosis compli- cated with diastematomyelia. [Methods] A retrospective study was conducted on 18 patients who underwent two-stage surgical treatment for severe rigid congenital scoliosis complicated with diastematomyelia in our hospital from August 2015 to August 2020. All the patients had halo-pelvic traction device set up in the primary stage, followed by continuous traction applied and then spinal osteotomy and instru- mented correction performed in the second stage. The clinical and imaging parameters were analyzed before and after traction, correction surgery and at the latest follow-up. [Results] The traction period lasted for (35.22±8.32) days on an average in the 18 patients. The height and weight of the 18 patients increased significantly after traction compared with those before traction (P＜0.05) . The second-stage correc- tion operation lasted for (301.71±82.12) min with intraoperative blood loss of (861.15±462.60) ml. All the patients were followed up for 12 to 36 months. The body height, deltoid skin wrinkling and SRS-22 score were significantly increased at the latest follow-up compared with those before surgery (P＜0.05) . In addition, the main curve Cobb's angle on coronal plane and kyphotic angle on the sagittal plane signifi- cantly decreased after traction, correction surgery and at the last follow-up (P＜0.05) . At the latest follow-up, vital capacity and forced expi- ratory volume in one second significantly increased (P＜0.05) , moreover, the plasma albumin significantly increased compared with those before traction (P＜0.05) . No implant displacement, loosening and fracture were noticed in anyone of them until the last follow-up. [Conclusion] The halo-pelvic traction is a safe and effective treatment for severe rigid congenital scoliosis complicated with diastematomyelia.