Halo pelvic distraction in combination with total spine osteotomy for treatment of severe scoliosis & kyphosis  

作　　者：田慧中[1] 马原[1] 吕霞[1] 

机构地区：[1]新疆医科大学第六附属医院脊柱外科,中国乌鲁木齐830002

出　　处：《中国矫形外科杂志》2014年第3期193-200,共8页Orthopedic Journal of China

摘　　要：[目的]介绍颅盆牵引加全脊柱截骨治疗重度脊柱侧凸和后凸的手术方法，并总结185例重度脊柱弯曲的治疗结果。[方法]对重度脊柱侧弯患者，先用颅盆牵引，使重弯变为轻弯，以便置入器械的安装，再在颅盆牵引下进行截骨矫正畸形和内固定手术，术后继续配戴颅盆环制动，术后第2d即可下床站立活动，给护理工作带来极大方便。[结果]作者自1983～2010年，采用此法治疗重度脊柱侧弯185例，平均矫正率70．32％。脊柱截骨断端能够达到坚固的骨性融合，矫正率丢失平均在5。以内，术后晚期并发脱钩4例，均经再次手术固定解决，对矫正效果无影响。1例术后1年并发感染，拆除置入器械后，伤口很快愈合，x线片示植骨愈合良好。1例并发神经根疼痛，尔后逐渐减轻，所有病例未见脊髓损伤和神经系统并发症发生。[结论]颅盆牵引加全脊柱截骨是治疗重度脊柱侧弯的有效方法，对那些仅用单纯器械无法安装、置人困难的病例，经颅盆牵引后，内固定器械容易安装，再加上全脊柱截骨，能使弯曲的脊柱进一步伸直，减轻了内固定器械所承受的负荷力，避免了脱钩、断棍的发生，为治疗重度脊柱侧弯的有效手段。[ Objectives] To report the records of 185 patients in whom severe scoliosis had been treated with preoperative Halo -pelvic distraction and following total spine osteotomy and internal fixation. [ Methods] Preop- erative halo - pelvic distraction was applied to all patients to reduce the severity of curvatures and make the follow- ing treatment possible. Then total spine osteotomy and internal fixation were performed to rectify the remained de- formity of the spine. Halo - pelvic distraction was maintained during the operation and postoperatively to limit the mobilization of the patients. At one day after the operation, the patients were able to get out of bed, stand up and move around, making nursing care more convenient. [Results] Between 1983 and 2003, a total of 185 cases of severe scoliosis were treated by this approach and an average correction rate of 70. 32% was achieved. Complete bone fusions were achieved at the cut ends of the bone. The average loss of correction rate was less than 5 de- grees. In the late stage of postoperative duration, rod release occurred in four cases and was resolved by second sur- gical intervention, showing no adverse effect on the clinical outcome. At postoperative one year, infective complica- tion occurred in one case and the patient fully recovered after the removal of the inserted device. X - ray examina- tion confirmed good healing of the bone grafts. Root pain occurred in one case and the patient gradually recovered without any medical intervention. None of the rest patients had evidence of spinal cord or nervous system complica- tions. [ Conclusion] Halo- pelvic distraction instrumentation, in combination with total spine osteotomy, is an effective treatment modality for severe spinal curvatures. Halo -pelvic distraction can facilitate the operative proce- dure for those cases that can not be cured by application of single instrumentation or have difficulty in the insertion of the internal fixation device. The combined total spine osteotomy can further correct the spin

关 键 词：重度脊柱侧弯 颅盆牵引 全脊柱截骨术 

分 类 号：R687.3[医药卫生—骨科学]