术中不同重量颅骨牵引对青少年特发性脊柱侧凸矫治的影响  

Effect of intraoperative skull traction with different weight on correction of adolescent idiopathic scoliosis

作　　者：王秀萍 张婧 王田田 WANG Xiu-ping;ZHANG Jing;WANG Tian-tian(Department of Orthopedics,Henan Province Luoyang Orthopedics Hospital(Henan Provincial Orthopaedic Hospital),Luoyang,Henan 471002,China;Operating Room,Henan Province Luoyang Orthopedics Hospital(Henan Provincial Orthopaedic Hospital),Luoyang,Henan 471002,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)骨科,河南洛阳471002 [2]河南省洛阳正骨医院(河南省骨科医院)手术室,河南洛阳471002

出　　处：《颈腰痛杂志》2023年第4期544-547,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨术中不同重量颅骨牵引对青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)矫治的影响。方法选择2016年1月~2020年6月在本院接受手术治疗的87例AIS患儿资料进行回顾性分析,根据术中颅骨牵引重量的不同分为A、B、C三组,A组26例接受高重量术中颅骨牵引(intraoperative skull-skeletal traction,ISST),B组33例接受常规ISST,C组28例不接受ISST。观察三组患者术前、术中、术后资料,采用多因素Logistic分析观察不同重量ISST对末次随访矫正度和运动诱发电位(motor evoked potential,MEP)变化率的影响。结果A组和C组主弯Cobb角差异存在统计学意义(P<0.05),A组和B组、B组和C组主弯Cobb角差异均无统计学意义(P>0.05)。A牵引重量、牵引后主弯Cobb角、牵引矫正率均显著高于B组(P<0.05);B组手术时间显著长于A组和C组(P<0.05);A组和B组融合节段数差异无统计学意义(P>0.05),C组融合节段数显著少于A组和C组(P<0.05);A组MEP变化显著高于B组和C组(P<0.05)。所有患儿体感诱发电位均无变化。A组和B组末次随访Cobb角均显著高于C组(P<0.05),A组矫正角度显著高于B组和C组(P<0.05)。逐步多元Logistic回归分析提示,高重量ISST是矫正角度和MEP事件的影响因素(P<0.05)。结论高重量ISST与术中和最终侧凸矫正增加相关,但高重量ISST可增加术中MEP发生风险,AIS矫正术术中进行ISST,可采用MEP进行神经监测,以提高手术安全性。Objective To investigate the effect of intraoperative skull traction with different weight on the correction of adolescent idiopathic scoliosis.Methods The data of 87 children with AIS who underwent surgery in our hospital from January 2016 to June 2020 were retrospectively analyzed.The children were divided into groups A,B and C according to the surgical methods.A total of26 patients in group A received high-weight ISST,33 patients in group B received conventional ISST,and 28 patients in group C did not receive ISST.The preoperative,intraoperative and postoperative data of the three groups were observed.The effects of different weight of ISST on the degree of correction and the changing rate of motor evoked potential(MEP)were observed by multivariate logistic analysis.Results Further analysis showed that there was significant difference in Cobb angle between group A and group C(P<0.05).There was no significant difference in Cobb angle between group A and group B,group B and group C(P>0.05).The traction weight,Cobb angle and traction correction rate of group A were higher than those of group B(P<0.05).The operation time in group B was higher than that in group A and C(P<0.05).There was no significant difference in fusion segments between group A and group B(P>0.05).The fusion segments in group C were lower than those in group A and group C(P<0.05).The change of MEP in group A was higher than that in group B and group C(P<0.05).There was no change in somatosensory evoked potential in all children.The last Cobb angle of group A and group B were both higher than group C,and the difference was statistically significant(P<0.05),and the correction angle in group A was significantly higher than that in group B and C(P<0.05).Stepwise multivariate logistic analysis showed that the correction angle of high weight ISST was an influencing factor of MEP(P<0.05).Conclusion High weight ISST is associated with the increase of intraoperative and final scoliosis correction,but high weight ISST increases the risk of intraoperative

关 键 词：青少年特发性脊柱侧凸 术中颅骨牵引 运动诱发电位 神经生理学监测 重量 

分 类 号：R682.13[医药卫生—骨科学]