Halo重力牵引与骨盆牵引对严重脊柱畸形患者截骨等级影响的比较

A comparative study of the influence of Halo-gravity and Halo-pelvic traction on osteotomy grades in severe spinal deformities

中文关键词:  脊柱侧凸  Halo-重力牵引  Halo-骨盆牵引  截骨等级  重度脊柱畸形  预测模型

英文关键词:Scoliosis  Halo-gravity traction  Halo-pelvic traction  Osteotomy grade  Severe spinal deformity  Predictive model

中文摘要:

  【摘要】 目的：评估术前牵引对截骨等级的影响，并比较Halo-重力牵引（halo-gravity traction，HGT）和Halo-骨盆牵引（halo-pelvic traction，HPT）在重度脊柱畸形治疗中的疗效差异。方法：回顾性分析2008年8月~2019年11月期间在中山大学附属第三医院接受术前牵引联合后路脊柱截骨融合手术的60例重度脊柱畸形患者的临床资料，其中男性22例，女性38例，年龄8~33岁（19.8±5.9岁），根据术前牵引方式分为HGT组（37例）与HPT（23例）组。分别于牵引前、牵引结束时及术后48个月的脊柱全长X线片上测量矢状面和冠状面Cobb角，并根据节段数计算矢状面畸形角比率（sagittal deformity angular ratio，SDAR）及后凸矫正率，通过截骨等级预测模型评估牵引前后截骨等级变化，并采用逆概率加权（inverse probability of treatment weighting，IPTW）比较两种牵引方式对截骨等级及矫形效果的影响。结果：60例患者均顺利完成治疗，牵引前患者矢状面后凸Cobb角为131.82°±30.29°，冠状面Cobb角为132.70°±28.77°，预测截骨等级为5.10±0.92；牵引结束时，矢状面后凸Cobb角为97.56°±33.54°，冠状面Cobb角为100.93°±30.93°，预测截骨等级为4.14±1.20，较牵引前显著降低（P＜0.001），实际截骨等级为4.34±0.98，也较牵引前显著降低（P＜0.001）。经IPTW校正后，HGT组矢状面Cobb角由牵引前的133.48°±23.68°降至牵引后111.23°±29.35°，HPT组则由134.96°±40.89°降至75.07°±25.49°。两种牵引方式在降低截骨等级方面无统计学差异（P＞0.05），但HPT在改善SDAR方面更具优势（P＝0.014），且后凸矫正率优于HGT（P＜0.001）。结论：术前HGT和HPT均可有效降低重度脊柱畸形患者所需截骨等级；HPT在改善矢状面畸形相关指标及后凸矫正率方面更具优势。

英文摘要:

  【Abstract】 Objectives: To evaluate the influence of preoperative traction on osteotomy grades, and to compare the therapeutic effects of halo-gravity traction(HGT) and halo-pelvic traction(HPT) in patients with severe spinal deformities. Methods: We retrospectively reviewed 60 patients with severe spinal deformities who underwent preoperative traction followed by posterior spinal osteotomy and fusion between August 2008 and November 2019. There were 22 males and 38 females, aged 8-33 years(19.8±5.9years). Patients were assigned to the HGT group(n=37) or the HPT group(n=23) according to the traction method used. Full-length standing radiographs were used to measure the sagittal and coronal Cobb angles before traction, at the end of traction, and at 48-month postoperative follow-up. Sagittal deformity angular ratio(SDAR) was calculated based on the Cobb angle and the number of involved segments. The kyphosis correction rate was also calculated. An osteotomy-grade prediction model was used to evaluate changes in the predicted osteotomy grade after traction. Inverse probability of treatment weighting(IPTW) was applied to compare the two traction strategies with respect to osteotomy grade and correction outcomes. Results: All 60 patients completed the treatment successfully. Before traction, the mean sagittal kyphotic Cobb angle was 131.82°±30.29°, and the mean coronal Cobb angle was 132.70°±28.77°. The predicted osteotomy grade was 5.10±0.92. At the end of traction, the sagittal kyphotic Cobb angle was 97.56°±33.54°, and the coronal Cobb angle was 100.93°±30.93°. The predicted osteotomy grade was 4.14±1.20, which was significantly lower than that before traction(P<0.001). The actual osteotomy grade was 4.34±0.98, also significantly lower than that before traction(P<0.001). After IPTW adjustment, the sagittal Cobb angle in the HGT group decreased from 133.48°±23.68° pre-traction to 111.23°±29.35° post-traction, whereas in the HPT group it decreased from 134.96°±40.89° to 75.07°±25.49° post-traction. The two traction methods achieved similar reductions in osteotomy grade(P>0.05). However, HPT produced greater improvement in SDAR(P=0.014), which also yielded a higher kyphosis correction rate than HGT(P<0.001). Conclusions: Preoperative HGT and HPT can both reduce the osteotomy grade required for surgical correction in severe spinal deformity. HPT provides better sagittal correction and kyposis corrective rate than HGT.