一期头盆环牵引联合二期矫形手术治疗极重度僵硬性脊柱侧后凸畸形  

Halo-pelvic traction combined with staged correction surgery in the treatment of extremely severe and rigid kyphoscoliosis

作　　者：周立金[1] 刘景伟 海涌[1] 杨晋才[1] 苏庆军[1] 尹鹏 张苡齐 唐新力 许春阳 高海峰 庞大明 姚瑞章 ZHOU Li-jin;LIU Jing-wei;HAI Yong;YANG Jin-cai;SU Qing-jun;YIN Peng;ZHANG Yi-qi;TANG Xin-li;XU Chun-yang;GAO Hai-feng;PANG Da-ming;YAO Rui-zhang(Department of Orthopedic Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing,100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100020

出　　处：《中国骨与关节杂志》2022年第6期445-449,共5页Chinese Journal of Bone and Joint

摘　　要：目的 评估头盆环牵引 (halo-pelvic traction,HPT) 联合二期矫形手术治疗极重度僵硬性脊柱侧后凸畸形 (severe and rigid scoliosis,SRS) (Cobb’s 角 > 140°) 患者的疗效及并发症。方法 纳入我中心行一期 HPT,二期脊柱侧凸矫形的极重度 SRS 的病例 12 例。患者主弯或后凸 Cobb’s 角 > 140°,柔韧性 < 30%。对牵引前、一期 HPT 后及二期矫形术后,患者的身高,站立位脊柱全长正侧位 X 线片主弯及后凸 Cobb’s 角,双肩高度差,双髂高度差,冠状面平衡 (distance between C;plumb line and center sacral vertical line,C7PL-CSVL) 偏移距离等进行评估。结果 患者主弯或后凸由术前的 (162.5±17.3) ° 在一期 HPT 后改善至(75.7±14.3) °,在二期矫形术后改善至 (57.7±16.1) °,改善率达 64.5%。一期 HPT 及二期矫形术后患者身高、双肩高度差及 C7PL-CSVL 偏移距离等较牵引前也有明显改善,差异有统计学意义。一期 HPT 中 1 例出现 C;神经根麻痹,1 例出现皮肤破溃感染。二期矫形术中 1 例出现脑脊液漏,1 例出现一过性双下肢瘫痪。患者并发症在处理后均好转。结论 HPT 联合二期矫形手术是一种安全且行之有效的治疗 Cobb’s 角 > 140° 的极重度 SRS 的方式。Objective To evaluate the efficacy and safety of halo-pelvic traction (HPT) combined with staged corrective surgery in the treatment of extremely severe and rigid scoliosis (Cobb’s angle > 140°).Methods Twelve cases of extremely severe rigid scoliosis with one-stage HPT traction were included.All underwent staged correction surgery.The patient had a major coronal curve or kyphosis > 140° and a flexibility < 30%.The patient’s height,main curve,height difference between the two shoulders,height difference between the two iliacs,and the C7PL-CSVL distance were evaluated before traction,after HPT,and after correction surgery.Results The main curve or kyphosis was improved from (162.5±17.3) ° before operation to (75.7±14.3) ° after HPT,and to(57.7±16.1) ° after correction surgery.The corrective rate was 64.5%.The height,shoulder height difference andC7PL-CSVL distance of patients after HPT and correction surgery were also significantly improved compared with those before traction.One patient developed C;root palsy during traction,one patient developed skin ulceration infection,one patient developed cerebrospinal fluid leakage during correction surgery,and one patient developed transient lower extremity paralysis.Complications in all patients were relieved after treatment.Conclusions The combination of HPT and correction surgery is a safe and effective method for the treatment of extremely severe rigid scoliosis with Cobb’s angle > 140°.

关 键 词：牵引术 脊柱侧凸 矫形外科手术 

分 类 号：R687.3[医药卫生—骨科学] R682.3[医药卫生—外科学]