改良头盆环牵引联合二期后路椎弓根钉内固定植骨融合术治疗重度脊柱畸形合并肺功能不全  

Clinical efficacy of modified halo-pelvic traction combined with posterior pedicle screw internal fixation and fusion in treatment of severe spinal deformities complicated with pulmonary dysfunction

作　　者：刘珵[1] 徐贝宇 漆龙涛 王诗军[2] 王宇[2] 李淳德[2] LIU Cheng;XU Bei-yu;QI Long-tao;WANG Shi-jun;WANG Yu;LI Chun-de(Department of Emergency Department,Peking University First Hospital,Beijing 100034,China;不详)

机构地区：[1]北京大学第一医院急诊科,北京100034 [2]北京大学第一医院骨科,北京100034

出　　处：《中国骨与关节损伤杂志》2021年第11期1145-1148,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨改良头盆环牵引联合二期后路椎弓根钉内固定植骨融合术治疗重度脊柱畸形合并肺功能不全的临床疗效。方法回顾性分析自2017-01—2019-12采用改良头盆环牵引联合二期后路椎弓根钉内固定植骨融合术治疗的44例重度脊柱畸形合并肺功能不全,比较牵引前、牵引结束后1 d、二期手术后1周以及末次随访时冠状位侧凸Cobb角、矢状位后凸Cobb角,比较牵引前与牵引结束后1 d身高、睡眠状况评分、基本生活活动能力评分、肺功能用力肺活量(Forced vital capacity,FVC)以及FVC与预期值的比(FVC%)。结果 44例均顺利完成手术并获得至少12个月的随访。1例出现左侧髂骨钉松动,1例出现吞咽、排尿困难,1例出现右下肢肌力降低,1例出现内固定近端皮肤破损,对症治疗后相关症状均缓解。牵引结束后1 d身高较牵引前身高明显提高,牵引结束后1 d、二期手术后1周以及末次随访时冠状位侧凸Cobb角、矢状位后凸Cobb角较牵引前小,二期手术后1周以及末次随访时冠状位侧凸Cobb角、矢状位后凸Cobb角较牵引结束后1 d小,差异有统计学意义(P<0.05)。牵引前与牵引结束后1 d睡眠状况评分比较差异无统计学意义(P>0.05)。牵引结束后1 d基本生活活动能力评分较牵引前降低,FVC、FVC%较牵引前大,差异有统计学意义(P<0.05)。结论改良头盆环牵引联合二期后路椎弓根钉内固定植骨融合术治疗重度脊柱畸形合并肺功能不全临床矫形效果满意,能有效改善患者肺功能,安全、有效性较高。Objective To evaluate the clinical efficacy of modified halo-pelvic traction(HPT) combined with posterior pedicle screw internal fixation and fusion in the treatment of severe spinal deformities complicated with respiratory dysfunction.Methods combined with posterior pedicle screw internal fixation and fusion were retrospectively reviewed. The scoliosis Cobb’s angle and kyphosis Cobb’s angle were assessed before traction, 1 day after traction, 1 week after surgery and at last follow-up. The changes of height, sleeping(SRSS score), ability of daily living(BADL score) and pulmonary function(FVC and FVC%) were also assessed before traction and 1 day after traction.Results All 44 cases successfully completed the operation and were followed up for at least 12 months. Four patients developed complications after HPT. One case experienced pin loosening of the left iliac. One case experienced difficult swallowing and urination. One case experienced decrease in muscle strength in the right lower extremity, and the proximal skin of operation site was damaged in 1 case. All these symptoms disappeared after treatment. The height at 1 d after traction was higher than that before traction. There was a significant decrease of scoliosis and kyphosis angle at 1 day after traction, 1 week after surgery and at last follow-up compared with the curves prior to traction(P<0.05). And a significant decrease of scoliosis and kyphosis angle at 1 week after surgery and at last follow-up compared with the curves at 1 d after traction was also found(P<0.05). The SRSS score at 1 d after traction was not significantly different from that before traction(P>0.05), and the BADL score at 1 d after traction was lower than that before traction(P<0.05). Both FVC and FVC% after traction were significantly higher than those before traction(P<0.05).Conclusion The modified HPT combined with posterior pedicle screw internal fixation and fusion could be used to help patients with severe spinal deformities complicated with pulmonary dysfunction, which ha

关 键 词：改良头盆环牵引 重度脊柱畸形 肺功能 并发症 

分 类 号：R687.3[医药卫生—骨科学]