头盆环牵引治疗重度僵硬型脊柱侧后凸伴复杂椎管内畸形的临床研究  

Study on the safety and clinical efficacy of osteotomy after halo pelvic traction in severe scoliosis accompanied with split cord malformation

作　　者：王力航 陈啟鸰 陆廷盛 姚书眈 蒲兴魏 罗春山 Wang Lihang;Chen Qiling;Lu Tingsheng;Yao Shudan;Pu Xingwei;Luo Chunshan(Department of Spine Surgery,Guizhou Orthopedic Hospital,Guiyang 550004,China)

机构地区：[1]贵州省骨科医院脊柱外科,贵阳550004

出　　处：《中华外科杂志》2021年第5期370-377,共8页Chinese Journal of Surgery

基　　金：贵州省科技支撑计划项目(黔科合支撑[2020]4Y131);贵州省科技计划项目(黔科合基础[2019]1183)。

摘　　要：目的探讨头盆环牵引治疗重度僵硬型脊柱侧后凸伴复杂椎管内畸形的临床效果。方法回顾性分析2015年8月至2019年8月贵州省骨科医院脊柱外科收治的14例重度僵硬型脊柱侧后凸伴复杂椎管内畸形患者的临床资料。男性6例,女性8例,年龄(19.8±5.0)岁(范围:13~34岁)。患者均在头盆环牵引3~7周后行脊柱矫形手术治疗。收集患者牵引时间,以及牵引前后和矫形术后身高、主弯冠状面和矢状面Cobb角、肺功能、营养状态等。各评价指标的比较采用配对样本t检验。结果14例患者牵引时间为(35.2±8.3)d(范围:20~49 d),身高由牵引前的(156.7±7.6)cm(范围:141~166 cm)增至牵引后的(167.0±6.4)cm(范围:154~177 cm)(t=-10.49,P<0.01)。主弯冠状面Cobb角由牵引前的(117.4±17.2)°(范围:91°~176°)降至牵引后的(56.4±8.1)°(范围:44°~68°)(t=13.90,P<0.01);矢状面Cobb角由牵引前的(92.5±11.6)°(范围:62°~132°)降至牵引后的(41.7±7.7)°(范围:29°~51°)(t=12.11,P<0.01)。牵引过程中均未出现钉道松动、感染等并发症,未发生神经功能减退。9例患者行单节段顶椎经椎弓根截骨矫形术,5例行双节段邻椎不对称短缩截骨术,患者均未行骨性纵裂切除。术后肺功能、营养状态均较牵引前改善(P均<0.01)。术后随访(22.5±9.1)个月(范围:12~36个月)。末次随访时,患者冠状面Cobb角为(56.3±7.1)°,矢状面Cobb角为(37.7±6.5)°,与牵引后相比,差异均无统计学意义(t=0.16,P=0.88,t=2.28,P=0.32)。患者均未出现内固定移位、松动及断裂。结论头盆环牵引治疗重度僵硬型脊柱侧后凸伴复杂椎管内畸形初步观察安全有效,值得进行大样本研究进一步证实。Objective To investigate the safety and clinical efficacy of osteotomy after halo pelvic traction in severe scoliosis accompanied with split cord malformation.Methods The clinical data of 14 patients with severe scoliosis accompanied with split cord malformation admitted to the Department of Spinal Surgery,Guizhou Orthopedic Hospital from August 2015 to August 2019 were retrospectively analyzed.There were 6 males and 8 females,aged(19.8±5.0)years(range:13 to 34 years).All patients received spinal orthopedic surgery after halo pelvic traction for 3 to 7 weeks.The data of traction time,height,Cobb angle in the main curved coronal plane and sagittal plane,lung function and nutritional status of the patient were collected before and after the treatment.Paired t test was used to compare the evaluation indexes.Results The traction time of the 14 patients was(35.2±8.3)days(range:20 to 49 days),and the height of them increased from(156.7±7.6)cm(range:141 to 166 cm)before traction to(167.0±6.4)cm(range:154 to 177 cm)after traction(t=-10.49,P<0.01).The Cobb angle on the main curved coronal plane decreased from(117.4±17.2)°(range:91°to 176°)before traction to(56.4±8.1)°(range:44°to 68°)after traction(t=13.90,P<0.01).The sagittal Cobb angle decreased from(92.5±11.6)°(range:62°to 132°)before traction to(41.7±7.7)°(range:29°to 51°)after traction(t=12.11,P<0.01).No complications such as loosening of nailing and infection occurred during traction,and no decrease of nerve function occurred.Nine patients underwent single segment acromial transpedicle osteotomy and five underwent double segment adjacent asymmetric shortening osteotomy.None of the patients underwent longitudinal fracture resection.The lung function and nutritional status were improved after traction and surgery(all P<0.01).Postoperative follow-up was(22.5±9.1)months(range:12 to 36 months).At the last follow-up,the coronal Cobb angle was(56.3±7.1)°,and the sagittal Cobb angle was(37.7±6.5)°,showing no statistically significant difference from

关 键 词：脊柱后凸 脊柱侧凸 头盆环牵引 脊髓纵裂 

分 类 号：R687.3[医药卫生—骨科学]