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北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (5): 875-880. doi: 10.19723/j.issn.1671-167X.2020.05.013

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短期头盆环牵引配合手术治疗重度脊柱畸形的临床疗效

徐贝宇1,漆龙涛1,王宇1,∆(),李淳德1,∆(),孙浩林1,王诗军1,于峥嵘1,赵耀1,刘龙龙2   

  1. 1.北京大学第一医院骨科,北京 100034
    2.临汾市第二人民医院,山西临汾 041000
  • 收稿日期:2018-06-26 出版日期:2020-10-18 发布日期:2020-10-15
  • 通讯作者: 王宇,李淳德 E-mail:wangyuspine@sina.com;Lichunde@vip.sina.com

Clinical efficacy of short-term halo-pelvic traction combined with surgery in the treatment of severe spinal deformities

Bei-yu XU1,Long-tao QI1,Yu WANG1,∆(),Chun-de LI1,∆(),Hao-lin SUN1,Shi-jun WANG1,Zheng-rong YU1,Yao ZHAO1,Long-long LIU2   

  1. 1. Department of Orthopedics, Peking University First Hospital, Beijing 100034, China
    2. Department of Orthopedics, Linfen Second People’s Hospital, Shanxi 041000, China
  • Received:2018-06-26 Online:2020-10-18 Published:2020-10-15
  • Contact: Yu WANG,Chun-de LI E-mail:wangyuspine@sina.com;Lichunde@vip.sina.com

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摘要：

目的:探讨短期头盆环牵引配合手术治疗重度脊柱畸形的临床疗效。方法:选择北京大学第一医院2015年1月—2018年5月应用一期头盆环牵引配合二期手术治疗的重度脊柱畸形患者病例资料进行回顾性分析,共收集到病例24例,其中男性9例,女性15例,平均年龄(28.8±10.0)岁(12~48岁)。分别测量牵引前、一期牵引后及矫形手术后身高、脊柱侧凸Cobb角、脊柱后凸Cobb角,比较患者牵引前、牵引后及手术后的身高、脊柱侧凸Cobb角和脊柱后凸Cobb角变化情况。结果:24例患者牵引时间(2.5±1.1)周(1~5周), 牵引前及牵引后身高分别为(141.7±11.2) cm(116~167 cm)和(154.1±9.5) cm(136~176 cm), 牵引后身高增加值为(12.4±4.6) cm(4~20 cm), 牵引后身高与牵引前差异有统计学意义(P<0.05)。牵引前、牵引后及手术后脊柱侧凸Cobb角分别为104.9°±35.0°(25°~158°)、64.8°±21.0°(19°~92°)、39.3°±17.0°(10°~70°), 牵引后及手术后脊柱侧凸Cobb角与牵引前差异有统计学意义(P<0.05),冠状位牵引矫形率为37.2%±10.9%(11.9%~51.2%),冠状位总矫形率为61.9%±12.6%(26.9%~79.0%)。牵引前、牵引后及手术后脊柱后凸Cobb角分别为106.9°±29.2°(54°~163°)、63.1°±17.1°(32°~92°)、39.0°±16.8°(10°~68°), 牵引后及手术后脊柱后凸Cobb角与牵引前差异有统计学意义(P<0.05),矢状位牵引矫形率为40.0%±10.7%(16.7%~55.5%),矢状位总矫形率为64.3%±10.7%(49.0%~87.5%)。结论:一期短期头盆环牵引配合二期手术是治疗重度脊柱侧凸一种安全、有效的方法,其临床矫形效果满意。

关键词: 短期, 头盆环牵引, 脊柱畸形, 重度, 矫形手术, 矫形率

Abstract:

Objective: To evaluate the clinical efficacy of short-term halo-pelvic traction (HPT) combined with surgery in the treatment of severe spinal deformities. Methods: In the study, 24 patients diagnosed as severe spinal deformity accepted the treatment of one-stage short-term HPT and two-stage surgery from January 2015 to May 2018 in our orthopedics department. 24 cases (9 males and 15 females) were retrospectively reviewed. The average age of the cohort was (28.8±10.0) years (12-48 years). The height, scoliosis angle, kyphosis angle, the height difference of shoulders, the height difference of crista iliaca, C7PL-CSVL and the perpendicular distance of S1 and the convex point of the patients were assessed at pre-traction, post-traction and post-surgery. The paired t test was used to analyze the difference among pre-traction, post-traction and post-surgery. Results: The average traction time of 24 cases was (2.5±1.1) weeks (1-5 weeks). The height of pre-traction and post-traction were (141.7±11.2) cm (116-167 cm) and (154.1±9.5) cm (136-176 cm) respectively, showing significant difference (P<0.05), and the increased height was (12.4±4.6) cm (4-20 cm). The average scoliosis angle before traction was 104.9°±35.0°(25°-158°), and it was significantly decreased in post-traction[64.8°±21.0°(19°-92°)] and post-surgery[39.3°±17.0° (10°-70°)] (P<0.05). The traction’s coronal correction rate was 37.2%±10.9% (11.9%-51.2%) and the total coronal correction rate was 61.9%±12.6%(26.9%-79.0%). The average kyphosis angle before traction was 106.9°±29.2°(54°-163°), and it was significantly decreased in post-traction [63.1°±17.1°(32°-92°)] and post-surgery [39.0°±16.8°(10°-68°)](P<0.05). The traction’s sagittal correction rate was 40.0%±10.7%(16.7%-55.5%) and the total sagittal correction rate was 64.3%±10.7%(49.0%-87.5%). The average C7PL-CSVL before traction was (3.2±2.8) cm, and it was significantly decreased in post-traction [(2.5±2.5) cm] (P<0.05). The perpendicular distance of S1 and the convex point before traction was (10.5±4.8) cm, and it was significantly decreased in post-traction[(8.4±3.5) cm] (P<0.05). Conclusion: The one-stage short-term HPT combined with two-stage surgery is a safe and effective procedure for severe spinal deformities. The clinical efficacy is satisfactory and the complication is relatively less.

Key words: Short-term, Halo-pelvic traction, Spinal deformities, Severe, Correction surgery, Correction rate

中图分类号: 

  • R682.1+3

图1

头盆环治疗典型病例"

表1

牵引前、一期牵引后及二期矫形手术后数据测量情况 (x-±s)"

Stage Pre-traction Post-traction Post-surgery
Height/cm 141.7±11.2 154.1±9.5* 155.0±9.5*
Scoliosis angle/(°) 104.9±35.0 64.8±21.0* 39.3±17.0*#
Kyphosis angle/(°) 106.9±29.2 63.1±17.1* 39.0±16.8*#
The height difference of shoulders/cm 2.4±1.8 1.3±0.9* 1.5±1.3*
The height difference of crista iliaca/cm 1.7±1.7 0.9±0.9* 1.0±1.0*
C7PL-CSVL/cm 3.2±2.8 2.5±2.5* 2.0±1.9*
The perpendicular distance of S1 and the convex point/cm 10.5±4.8 8.4±3.5* 6.7±3.7*
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