颅盆环牵引-脊柱后路矫形术治疗颈胸段脊柱侧凸15例观察  

Spinal Osteotomy and Gradual Halo-Pelvic Traction in Treatment of 15 Patients with Cervicothoracic Scoliosis

作　　者：胡正军[1] 梁益建[1] 汪飞[1] 赵登[1] 

机构地区：[1]成都市第三人民医院,四川成都610031

出　　处：《现代临床医学》2016年第4期277-279,共3页Journal of Modern Clinical Medicine

摘　　要：目的：评价颅盆环牵引-脊柱后路矫形术治疗颈胸段脊柱侧凸畸形的疗效。方法：15例颈胸段脊柱侧凸患者,入院后均行颅盆环牵引,经牵引脊柱侧凸部分改善后二期行脊柱后路截骨矫形植骨融合椎弓根螺钉内固定术。手术前后分别测量患者颈胸段脊柱侧弯Cobb角、身高及顶椎偏移距离,对比治疗前后的效果。结果：15例患者均行颅盆环牵引术,术后持续牵引,二期行脊柱后路矫形植骨融合椎弓根螺钉内固定术,患者脊柱侧凸Cobb角由手术前的平均（85.9±10.4）!矫正至平均（25.2±10.3）!,矫正率73.3%;身高由牵引前平均135.7±15.4 cm增高至平均146.7±10.4 cm,顶椎偏移距离由术前的平均10.7±3.4 cm显著降低至平均3.7±1.4 cm（P〈0.05）;患者脊柱冠状面失平衡明显改善;身体外观、行走姿势及心肺功能均明显改善,无严重并发症发生。所有患者平均随访时间2.6年（1.5~4.0年）,无内固定物断裂失效,无明显矫正角度丢失。结论：通过颅盆环牵引-脊柱后路矫形术可以有效治疗颈胸段脊柱侧凸畸形,纠正患者冠状面失平衡,改善患者外观。其中颅盆环牵引术通过逐步调整牵引高度来减小脊柱侧凸畸形的程度,降低了二期行脊柱后路截骨矫形手术难度及风险,是一种安全有效的治疗方法。Objective： To evaluate the clinical results of correction of cervicothoracic scoliosis by spinal osteotomy plus gradual halo-pelvic traction. Methods： 15 patients with serious cervicothoracic scoliosis who underwent surgical treatment were studied. Depended on patients＇ conditions,gradual halo-pelvic traction were performed and maintained in a period of time,and then posterior spinal osteotomy and pedicle screw fixation were performed to achieve final correction. Both preoperative and postoperative Cobb＇s angle,height,and apical vertebral translation were recorded. Results： The average Cobb ＇s angle was corrected to（ 25. 2 ± 10. 3） ° from（ 85. 9 ± 10. 4） °. A mean correction rate of 73. 3% was achieved. The mean height was 146. 7± 10. 4 cm after treatment,higher than 135. 7 ± 15. 4 cm before treatment. The average apical vertebral offset distance were improved from 10. 7 ± 3. 4 cm to 3. 7 ± 1. 4 cm. Differences between preoperative and postoperative Cobb＇s angle,height,and apical vertebral offset distance had statistical significance（ P〈0. 05）. Restoration of coronal alignment were significant. The appearance,walking posture,and cardiopulmonary function were improved. No serious complications occurred. Mean follow-up was2. 6 years（ ranged from 1. 5 to 4. 0 years）. The fixation and correction angle were well maintained. Conclusion： The halo-pelvic traction and spinal osteotomy provides a slow and safe correction of cervicothoracic scoliosis. It restores the spinal coronal alignment,and improves the appearance. Correcting cervicothoracic scoliosis by halo-pelvic traction before two-stage spinal osteotomy is more satisfied and safe because the traction can relax the stiffness and stretch the spine.

关 键 词：颈胸段脊柱侧凸 颅盆环牵引 截骨矫形 

分 类 号：R682.13[医药卫生—骨科学]