牵引结合后路手术治疗重度脊柱侧凸的疗效分析  

Effect of halo-femoral traction and posterior correction for severe scoliosis

作　　者：张宏其[1] 王永福[1] 唐明星[1] 刘金洋[1] 赵迪[1] 刘少华[1] 陈凌强[1] 郭超峰[1] 

机构地区：[1]中南大学湘雅医院脊柱外科,长沙410008

出　　处：《中国矫形外科杂志》2009年第21期1617-1620,共4页Orthopedic Journal of China

摘　　要：[目的]探讨Halo-股骨髁上牵引结合后路矫形对柔韧性30%～40%的重度脊柱侧凸患者的疗效。[方法]对2000年1月～2006年6月治疗的41例柔韧性30%～40%重度脊柱侧凸患者,按照是否行牵引治疗分为两组。牵引组A组22例,主侧凸平均Cobb’s角91.2°;对照组B组19例,主侧凸平均Cobb’s角87.5°。[结果]两组无严重神经系统并发症。A组平均牵引18d(14～22d)后主侧凸平均矫正46%,14例肺功能减退患者均改善。两组均行一期后路松解三维矫形术,术后C7～S1偏移值、顶椎偏移矫正A组优于B组。A组主侧凸平均矫正55.2°,B组45.7°,A组优于B组(P<0.05)。A组平均随访40个月,B组平均随访42个月,末次随访两组平均冠状面矫正丢失分别为3°、2.4°,矢状面无丢失,两组均获骨性融合。[结论]对于柔韧性30%～40%的重度脊柱侧凸,术前Halo-股骨髁上牵引可改善肺功能,结合牵引下后路松解矫形术可以获得更好的畸形矫正和躯干平衡,减少术中术后并发症。[ Objective ] To discuss the efficacy of Halo - femoral traction combined with posterior surgery for idiopathic scoliosis. [ Methods] A total of 41 patients with severe idiopathic scoliosis （flexibility of 30% - 40% ） from Jan. 2000 to Jun. 2006 were retrospectively reviewed. The patients were derided into 2 groups according to whether preoprative traction was used （nl =22, n2 = 19 respectively） . The average preoperative Cobb＇ s angle was 91.2° in group A and 87. 5° in group B. [ Results] No severe neural complications were noted in both groups. Traction was used in group A for an average of 18 days before spinal fusion （ range, 14 -22 days） . After traction , the patients in group A achieved a mean correction of 46%, and 14 of them with pulmonary function compromise got respiratory function improved. All 41 patients underwent posterior extensive release and correction. Shorter operative time and better C7PL- CSVL distance and AVT （apical vertebra translation） corretion were achieved in group A. The major coronal curve was reduced by 55.2° and 45.7°after posterior spinal fusion, respectively. The average loss of correction was 3° for major coronal curves at an average of 40 - month follow - up in group A, and 2.4°at an average of 42 - month follow - up in group B. All cases got solid bony fusion. [ Conclusion ] Perioperative halo - femoral traction can improve pulmonary function and reduce operative complications of severe scoliosis with flexibility of 30% or 40%. Better deformity correction and trunk balance can be achieved by traction as an adjunct to posterior extensive release and correction.

关 键 词：脊柱侧凸 重度侧凸 牵引 后路矫形 

分 类 号：R687.3[医药卫生—骨科学]