头盆环牵引后截骨矫形治疗重度脊柱侧后凸伴骨性脊髓纵裂的安全性与疗效

Safety and efficacy of osteotomy after halo pelvic traction in severe scoliosis accompanied with split cord malformation

中文关键词:  重度脊柱侧后凸  头盆环牵引  截骨矫形  脊髓纵裂  疗效

英文关键词:Severe scoliosis  Halo pelvic traction  Osteotomy  Split cord malformation  Curative effect

中文摘要:

  【摘要】 目的：探讨头盆环牵引后截骨矫形治疗重度脊柱侧后凸伴骨性脊髓纵裂的安全性及临床疗效。方法：2012年8月~2019年8月我院收治8例重度脊柱侧后凸伴骨性脊髓纵裂患者，均行头盆环牵引后截骨矫形治疗，未行骨性纵裂切除。随访时间为12～36个月（20.33±8.11个月）。分析牵引时间，牵引前、后与矫形术后、末次随访时的身高、体重、主弯冠状面Cobb角、矢状面Cobb角，牵引前、后及矫形术后肺活量（vital capacity，VC）、用力肺活量（forced vital capacity，FVC）、第一秒用力呼气量（forced expiratory volume in one second，FEV1）、FEV1/FVC（%）、PO2、PCO2、三头肌皮皱厚度、血清白蛋白浓度、血清转铁蛋白浓度等指标。结果：8例患者牵引时间为22~49d（32.13±7.66d）。牵引前身高143~165cm（155.13±6.28cm），牵引后身高156~175cm（167.88±4.66cm），增高12.75±2.11cm，矫形术后及末次随访时身高无明显变化。牵引前体重47.20±4.55kg，牵引后48.84±4.19kg，体重增加1.92±0.32kg，矫形术后49.21±4.22kg，末次随访时50.32±5.36kg，体重随营养状态改善逐渐增加。牵引前主弯冠状面Cobb角92°~176°（119.50°±15.13°），牵引后46°~66°（54.88°±5.88°），矫正率39％~68%[（53.55±7.76）%]；矫形术后43°～66°（51.34°±7.47°），矫正率40％~72%[（58.54±8.87）%]；末次随访时矫正角度无丢失。牵引前矢状面Cobb角62°~132°（91.13°±10.23°），牵引后29°~51°（40.48°±6.32°），矫正率46％~71%[（51.17±12.14）%]；矫形术后30°～55°（36.11°±6.19°），矫正率47％~72%[（52.55±12.69）%]；末次随访时矫正角度无丢失。牵引前VC为3.75±0.26L，牵引后4.20±0.04L，改善率为（12.85±7.72）%，矫形术后4.22±0.05L。牵引前FVC为3.65±0.26L，牵引后4.14±0.04L，改善率为（14.21±8.30）%，矫形术后4.16±0.04L。牵引前FEV1为3.34±0.22L，牵引后3.54±0.15L，改善率为（6.44±2.78）%，矫形术后3.54±0.15L。牵引后及矫形术后FEV1/FVC、PO2、PCO2均回归正常范围。牵引后较牵引前三头肌皮皱厚度改善（11.55±4.60）%，白蛋白浓度改善（21.96±7.75）%，转铁蛋白浓度改善（23.13±8.51）%；矫形术后较牵引前三头肌皮皱厚度改善（14.12±4.97）%，血清白蛋白浓度改善（23.12±7.87）%，血清转铁蛋白浓度改善（25.43±8.18）%。所有患者牵引中及矫形术中、术后均未出现不可逆性神经功能损伤，牵引过程中均未出现钉道松动、感染等并发症。末次随访时均未出现内固定移位、松动及断裂。结论：头盆环牵引后截骨矫形治疗重度脊柱侧后凸伴骨性脊髓纵裂安全有效，可避免风险更高的骨嵴切除术，不失为首选方案之一。

英文摘要:

  【Abstract】 Objectives: To investigate the safety and clinical efficacy of osteotomy after halo pelvic traction for the treatment of severe scoliosis accompanied with split cord malformation. Methods: The data of eight cases of severe scoliosis with split cord malformation treated in our hospital from August 2012 to August 2019 were collected and retrospectively analyzed. None of them underwent resection of the longitudinal fissure. The follow-up period was 12-36 months. The traction time, height, weight, coronal Cobb angle, and sagittal Cobb angle were measured before and after traction, after orthopedic surgery, and at the final follow-up. Before and after traction, and after orthopedic surgery, vital capacity(VC), forced vital capacity(FVC), forced expiratory volume in one second(FEV1), FEV1/FVC(%), PO2, PCO2, triceps skin fold thickness, albumin concentration, and transferrin concentration were analyzed. Results: The traction time of 8 patients ranged from 22 days to 49 days(32.13±7.66 days). The height was 143-165cm(155.13±6.28cm) before traction and 156-175cm(167.88±4.66cm) after traction, increased by 12.75±2.11cm. There was no significant change in height after operation and at the last follow-up. The body weight was 47.20±4.55kg before traction, 48.84±4.19kg after traction, increased by 1.92±032kg, 49.21±4.22kg after orthopedic surgery, and 50.32±5.36kg at the last follow-up. The Cobb angle of the main curve was 92° to 176°(119.50°±15.13°) before traction, and 46° to 66°(54.88°±5.88°) after traction, with a correction rate of 39%-68%[(53.55±7.76)%]. It was 43°-66° (51.34°±7.47°) after orthopedic surgery, and the correction rate was 40%-72%[(58.54±8.87)%]. The correction angle was not lost at the last follow-up. The Cobb angle of sagittal plane was 62° to 132°(91.13°±10.23°) before traction and 29° to 51°(40.48°±6.32°) after traction, with a correction rate of 46%-71%[(51.17±12.14)%]. The correction rate was 47%-72%[(52.55±12.69)%] after orthopedic surgery. The correction angle was not lost at the last follow-up. VC was 3.75±0.26L before traction and 4.20±0.04L after traction. The improvement rate was (12.85±7.72)% and 4.22±0.05L after orthopedic surgery. FVC was 3.65±0.26L before traction and 4.14±0.04L after traction. The improvement rate was (14.21±8.30)% and 4.16±0.04L after orthopedic surgery. FEV1 was 3.34±0.22L before traction and 3.54±0.15L after traction. The improvement rate was (6.44±2.78)% and 3.54±0.15L after orthopedic surgery. FEV1/FVC, PO2 and PCO2 returned to normal range after traction and orthopedic surgery. The thickness of triceps skin fold, albumin and transferrin were improved by (11.55±4.60)%, (21.96±7.75)% and (23.13±8.51)%, compare with that before traction. Also, the thickness of triceps skin fold was improved by (14.12±4.97)%, albumin concentration was (23.12±7.87)%, and transferrin concentration was (25.43±8.18)%. All patients had no irreversible neurological dysfunction during and after the operation, and there were no complications such as loosening of nail track and infection during traction. At the last follow-up, no internal fixation displacement, loosening and fracture occurred. Conclusions: Halo pelvic traction is a safe and effective treatment for severe scoliosis accompanied with split cord malformation. It can avoid the higher risk of ridge resection, and can be considered as one of the first choice.