术前牵引对重度脊柱畸形矫形手术发生神经损伤并发症的影响

The effect of preoperative traction on the complication of nerve injury in severe spinal deformity correction surgery

中文关键词:  重度脊柱畸形  牵引术  矫形手术  神经损伤

英文关键词:Severe spinal deformities  Traction surgery  Corrective surgery  Neurological injury

中文摘要:

  【摘要】 目的：探讨术前牵引对重度脊柱畸形矫形手术患者神经损伤并发症的影响。方法：对2019年12月~2022年12月在我院住院行矫形手术治疗的196例重度脊柱畸形患者进行回顾性分析，其中38例极重度僵硬性脊柱畸形患者术前应用头盆环牵引（Halo-pelvic traction，HPT），男17例，女21例；年龄14～30岁 （20.12±7.82）岁，纳入HPT组；158例一般重度脊柱畸形患者术前采用枕颌带-下肢牵引带皮牵引（skin traction：ST），男61例，女97例；年龄10～30岁（15.55±10.38），纳入ST组。牵引后均一期行后路矫形固定融合术。收集两组患者的一般资料、手术相关资料和治疗前后的影像学资料（牵引前、牵引后和手术后），计算术前牵引和手术对畸形矫正的贡献率，记录两组患者术中发生神经电生理监测（intra-operative neurophysiological monitoring，IONM）异常和术后神经损伤并发症发生的情况。结果：HPT组患者术前侧凸Cobb角为142.48°±18.77°，头盆环牵引后改善至72.56°±13.26°，改善率为49.07%；手术矫形术后改善至55.76°±15.87°，改善率为60.87%；>Ⅳ级截骨5例，占13.16%；术中IONM出现异常10例，占26.32%；神经损伤3例，占7.90%。ST组患者术前侧凸Cobb角为97.90°±19.25°，牵引后为76.51°±12.68°，改善率为21.85%；矫形术后改善至41.58±15.84°，改善率为57.53%；>Ⅳ级截骨10例，占6.33%；术中IONM出现异常21例，占13.29%；神经损伤9例，占5.70%。两组脊柱高等级截骨无显著性差异（P>0.05）；两组术中IONM出现异常的发生率有显著性差异（P<0.05），但术后神经损伤并发症的发生率无显著性差异（P>0.05）。结论：脊柱畸形矫形术患者术前应用头盆环牵引或枕颌带-下肢牵引带皮牵引安全、有效，可减少重度脊柱畸形患者截骨矫形术中神经损伤并发症的风险。

英文摘要:

  【Abstract】 Objectives: To explore the effect of preoperative traction on nerve injury complications in patients with severe spinal deformities undergoing correction surgery. Methods: A retrospective analysis was conducted on 196 patients with severe spinal deformities who underwent orthopedic surgery in our hospital from December 2019 to December 2022. A total of 38 patients with severe stiff spinal deformity were treated with Halo-pelvic traction(HPT) before operation, including 17 males and 21 females, aged 20.12±7.82 years old(14 to 30 years), who were included into the HPT group. The other 158 patients with general severe spinal deformity undergone skin traction(ST) with occipital jaw and lower limb traction before operation were included into ST group, which included 61 males and 97 females, aged 15.55±10.38 years old(10-30 years). Posterior correction, fixation and fusion were performed after traction on both groups of patients. The general data, operation-related data, and imaging data before and after treatment(before traction, after traction, and after oepration) were collected, and the contribution rates of preoperative traction and operation to deformity correction were calculated. The abnormal conditions of intraoperative neurophysiological monitoring(IONM) and postoperative nerve injury complications were collected and compared between the two groups. Results: The preoperative Cobb angle of the HPT group was 142.48°±18.77°, which improved to 72.56°±13.26° after HPT, with an improvement rate of 49.07%; After corrective surgery, it was 55.76°±15.87°, with an improvement rate of 60.87%; 5 cases were of >Ⅳ grade osteotomy, accounting for 13.16%; There were 10 cases with abnormal IONM, accounting for 26.32%; And 3 cases of nerve damage, accounting for 7.90%. The preoperative Cobb angle of the patients in the ST group was 97.90°±19.25°, which was 76.51°±12.68° after traction, with an improvement rate of 21.85%; After corrective surgery, it was 41.58°±15.84°, with an improvement rate of 57.53%; 10 cases were of >Ⅳ grade osteotomy, accounting for 6.33%; There were 21 cases with abnormal IONM, accounting for 13.29%; And 9 cases of nerve injury, accounting for 5.70%. There was no significant difference in high-grade spinal osteotomy between the two groups(P>0.05). The difference in the incidence of abnormal IONM between the two groups was significant(P<0.05), however, there was no significant difference in the incidence of postoperative nerve injury complications(P>0.05). Conclusions: The applications of HPT and ST occipital jaw-lower limb traction before orthopedic surgery are both effective and safe in patients with spinal deformity, which can reduce the level of spinal osteotomy and reducing the risk of nerve injury complications in severe spinal deformity patients undergoing correction surgery.