大重量Halo-股骨髁上牵引辅助一期后路手术治疗重度僵硬型非特发性脊柱侧凸的临床疗效  

One-stage posterior surgery assisted with high-weight halo-femoral traction for the treatment of severe rigid non-idiopathic scoliosis

作　　者：张宏其[1] 王昱翔[1] 唐明星[1] 郭超峰[1] 刘少华[1] 邓盎[1] 高琪乐[1] 吴建煌[1] 刘金洋[1] 

机构地区：[1]中南大学湘雅医院脊柱外科湘雅脊柱外科中心,长沙410008

出　　处：《中国矫形外科杂志》2014年第23期2139-2143,共5页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81271940);湖南省自然科学基金重点项目(编号:12JJ2043);湖南省"芙蓉学者"项目

摘　　要：[目的]探讨大重量Halo-股骨髁上牵引辅助一期后路手术治疗重度僵硬型非特发性脊柱侧凸的可行性及临床疗效。[方法]2007年1月~2012年2月本院实施587例脊柱侧弯矫形术,对其中行Halo-股骨髁上牵引治疗且临床资料完整的35例重度僵硬型非特发性脊柱侧凸患者进行回顾性分析。[结果]随访14~72个月（平均42个月）。Halo-股骨髁上牵引治疗结束后侧凸Cobb角平均（49±11）°,与术前冠状面Cobb角相比,差异具有统计学意义;侧凸纠正率达平均（40.9±9.3）%。后路矫形术后侧凸Cobb角与术前冠状面Cobb角相比,差异具有统计学意义;侧凸矫正率为平均（52.6±8.2）%。术后矢状面后凸Cobb角为（34±10）°,与术前矢状面后凸Cobb角相比,差异具有统计学意义;后凸矫正率平均（51.9±9.3）%。末次随访时冠状面Cobb角平均达（37.6±12）°,与术前冠状面Cobb角相比,差异具有统计学意义;矢状面后凸Cobb角平均（33±10）°,与术前矢状面后凸Cobb角相比,差异具有统计学意义。躯干移位经牵引后从平均（12.5±3.8）mm矫形至（6.94±4.6）mm,平均改善65.7%。1例患者牵引过程中Halo松动,予以更换,无其他明显牵引并发症发生。矫形术后无瘫痪、死亡等并发症,所有患者均未出现内固定松动或断裂。[结论]Halo-股骨髁上牵引在治疗重度僵硬型非特发性脊柱侧凸中是一种安全有效的治疗方案,结合单纯一期后路矫形手术,可大幅度提高重度非特发性脊柱侧凸畸形矫正疗效。[Objective] To investigate the feasibility and clinical efficacy of the treatment of severe rigid non- idiopathic scoliosis（ IS） by posterior surgery assisted with high- weight halo- femoral traction and posterior surgery. [Methods] A total of 35 patients with severe rigid non- IS among 587 patients who underwent scoliotic correction treated with halo- femoral traction before posterior spine fusion from January 2007 through February 2012 were studied. [Results] All patients were followed up for 14 ~ 72 months（ mean,42 months）. After halo- femoral traction,the coronal Cobb angle（ 49° ± 11°） was significantly different from that before surgery（ P 〈 0. 05）,while the scoliosis correction was（ 40. 9 ± 9. 3） %. After posterior orthopedics,the coronal Cobb angle was significantly different and the scoliosis correction was（ 52. 6 ± 8. 2） %. After surgery,the sagittal Cobb angle was（ 34 ± 10） °,which was significantly different from that before the surgery,while the kyphosis correction was（ 51. 9 ± 9. 3） %. The coronal Cobb’s angle at the last follow- up was（ 37. 6 ± 12） ° and the sagittal Cobb angle was（ 33 ± 10） °,both of which were significantly different from that before surgery. The trunk shift was significantly reduced from（ 12. 5 ± 3. 8）mm before surgery to（ 6. 94 ± 4. 6） mm after traction,and the average correction rate was 65. 7%. During follow- up,halo loosening occurred in one case and a new halo was replaced,but no other obvious complications occurred. After the surgery,no patient developed paralysis or died and no internal fixation loosening or fracture happened. [Conclusion] Halo- femoral trac-tion is a safe and effective method for the treatment of severe rigid non- IS, and combined with posterior instrumentation, it can enhance the correction rate for severe rigid non- IS.

关 键 词：Halo-股骨髁上牵引 重度僵硬型非特发性脊柱侧凸 后路手术治疗 

分 类 号：R682.3[医药卫生—骨科学]