Halo轮椅悬吊重力牵引在严重脊柱侧后凸儿童术前的应用价值

Preoperative Halo-gravity traction in the treatment of severe pediatric scoliosis and kyphosis

中文关键词:  脊柱侧后凸  牵引  矫正

英文关键词:Scoliosis  Kyphosis  Traction  Surgery  Correction

中文摘要:

  【摘要】 目的：探讨术前Halo轮椅悬吊重力牵引在治疗儿童严重脊柱侧后凸中的应用价值。方法：2004年7月至2007年5月，对在我科术前行Halo轮椅悬吊重力牵引治疗且临床资料完整的17例严重脊柱侧后凸畸形儿童进行回顾性分析。其中男性8例，女性9例；年龄4～8岁，平均6.8岁。术前冠状面Cobb角85°～155°，平均116.4°；胸椎后凸Cobb角45°～125°，平均90.2°。患者在后路矫形术前均行Halo轮椅悬吊重力牵引，最大牵引重量为体重的35%~60%，牵引4~15周（平均10.4周）后行后路矫形内固定融合术。对患者术前Bending像、牵引后和术后的侧后凸纠正率进行统计比较。结果：平均最大牵引重量9kg，约占平均体重（16.5kg）的54.5%。1例患者在牵引2周时出现右侧臂丛神经麻痹，减轻牵引重量后逐渐恢复。矫形术后无瘫痪、呼吸衰竭和死亡发生。平卧Bending位X线片上侧凸纠正率平均15.4％，Halo轮椅悬吊重力牵引后侧凸纠正率平均38.4％，后路矫形术后侧凸矫正率为48.3％；胸椎后凸矫正率平均为38.8%。随访18～60个月，平均38个月，末次随访时冠状面矫正丢失率平均为2.3％，矢状面矫正丢失率平均为2.9％。牵引后肺功能及动脉血气分析结果改善明显。结论：术前Halo轮椅悬吊重力牵引可有效改善严重侧后凸儿童的柔韧性，并同时改善患者肺功能，但应注意与牵引相关的并发症。

英文摘要:

  【Abstract】 Objective：To evaluate the efficacy of preoperative Halo-gravity traction in the treatment of severe pediatric scoliosis and kyphosis.Method：17 patients with severe scoliosis and kyphosis received Halo-gravity traction prior to posterior spine fusion were studied retrospectively.There were 8 males and 9 females，with a mean age of 6.8 years（range，4-8 years）.The Cobb angle of coronal major curve and the thoracic kyphosis（T5-T12） were 116.4° and 90.2° respectively.All patients underwent preoperative Halo-gravity traction，and after the maximum weight traction for 4-15 weeks，a posterior instrumentation and fusion was performed.The correction rate of coronal major curve under supine position and that after Halo-gravity traction and after surgery was compared.Result：The maximum traction weight averaged 9kg.All patients were followed up for at least 18-month.One patient experienced transient brachial plexus palsy which resolved completely by decreasing the traction weight.No neurologic complication，death and respiratory failure occurred after surgery. Compared with the correction rate of 15.4％ in supine position，the correction rate of coronal major curve after Halo-gravity traction increased 23%（P<0.05）.The postoperative correction rate of coronal major curve and thoracic kyphosis were 48.3% and 38.8% respectively.At final follow-up，the loss of coronal and sagittal correction averaged 2.3% and 2.9% respectively.The pulmonary function and blood gas test improved significantly after Halo traction.Conclusion：Preoperative Halo-gravity traction followed by posterior instrumentation is effective for pediatric severe scoliosis and kyphosis due to improved flexibility and pulmonary function.However，the traction related complications should not be ignored.