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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (5): 875-880. doi: 10.19723/j.issn.1671-167X.2020.05.013

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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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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

CLC Number: 

  • R682.1+3

Figure 1

The typical case treated with HPT Male, 37 years old, Pott’s disease. The muscle strength of double lower limbs was grade Ⅳ and he had disorder of urination. The muscle strength of double lower limbs and urination function began to recover after 3 days’ traction and recovered totally after 2 weeks’ traction. A, B, C, the aesthetic posterior appearance before traction, after traction(2 weeks) and after surgery. The height was 158 cm, 165 cm and 167 cm respectively. D, E, F, the aesthetic lateral appearance before traction, after traction and after surgery. G, H, I, the anteroposterior view of X-ray before traction, after traction and after surgery, and the scoliosis angle was 153°, 87° and 42° respectively. J, K, L, the lateral view of X-ray before traction, after traction and after surgery, and the kyphosis angle was 125°, 85° and 75° respectively. "

Table 1

The measurement information before traction, post-traction and post-surgery(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*
[1] Hamzaoglu A, Alanay A, Ozturk C, et al. Posterior vertebral column resection in severe spinal deformities: a total of 102 cases[J]. Spine (Phila Pa 1976), 2011,36(5):E340-E344.
doi: 10.1097/BRS.0b013e3182015712
[2] Bouchoucha S, Khelifi A, Saied W, et al. Progressive correction of severe spinal deformities with halo-gravity traction[J]. Acta Orthop Belg, 2011,77(4):529-534.
[3] Gollogly S, Smith JT, Campbell RM. Determining lung volume with three-dimensional reconstructions of CT scan data: a pilot study to evaluate the effects of expansion thoracoplasty on children with severe spinal deformities[J]. J Pediatr Orthop, 2004,24(3):323-328.
pmid: 15105731
[4] Zhang Y, Xie J, Wang Y, et al. Thoracic pedicle classification determined by inner cortical width of pedicles on computed tomography images: its clinical significance for posterior vertebral column resection to treat rigid and severe spinal deformities-a retrospective review of cases[J]. BMC Musculoskelet Disord, 2014,15:278.
doi: 10.1186/1471-2474-15-278 pmid: 25124922
[5] O’Brien JP, Yac ACMC, Hodgson AR. Halo pelvic traction: a technic for severe spinal deformities[J]. Clin Orthop Relat Res, 1973,93:179-190.
doi: 10.1097/00003086-197306000-00018
[6] Arlet V, Papin P, Marchesi D. Halo femoral traction and sliding rods in the treatment of a neurologically compromised congenital scoliosis: technique[J]. Eur Spine J, 1999,8(4):329-331.
doi: 10.1007/s005860050182 pmid: 10483837
[7] Qiu Y, Liu Z, Zhu F, et al. Comparison of effectiveness of Halo-femoral traction after anterior spinal release in severe idiopathic and congenital scoliosis: a retrospective study[J]. J Orthop Surg Res, 2007,2:23.
doi: 10.1186/1749-799X-2-23 pmid: 18047681
[8] Zhang HQ, Gao QL, Ge L, et al. Strong halo-femoral traction with wide posterior spinal release and three dimensional spinal correction for the treatment of severe adolescent idiopathic scoliosis[J]. Chin Med J (Engl), 2012,125(7):1297-1302.
[9] 李彩红, 张梅清, 李晔, 等. 严重脊柱畸形患者术前颅-股骨牵引的护理[J]. 世界最新医学信息文摘:电子版, 2016,16(18):297-298.
[10] Hsu LC. Halo-pelvic traction: a means of correcting severe spinal deformities[J]. Hong Kong Med J, 2014,20(4):358-359.
pmid: 25243266
[11] Yang C, Wang H, Zheng Z, et al. Halo-gravity traction in the treatment of severe spinal deformity: a systematic review and meta-analysis[J]. Eur Spine J, 2017,26(7):1810-1816.
pmid: 27858237
[12] Pourtaheri S, Shah SA, Ditro CP, et al. Preoperative halo-gravity traction with and without thoracoscopic anterior release for skeletal dysplasia patients with severe kyphoscoliosis[J]. J Child Orthop, 2016,10(2):135-142.
doi: 10.1007/s11832-016-0721-0 pmid: 27016925
[13] Kim NH, Kim HJ, Moon SH, et al. 20-year-follow up of treatment using spine osteotomy and halo-pelvic traction for tuberculous kyphosis[J]. Asian Spine J, 2009,3(1):27-31.
pmid: 20404943
[14] Hodgson AR. Halo-pelvic traction in scoliosis[J]. Isr J Med Sci, 1973,9(6):767-770.
pmid: 4724284
[15] Dove J, Hsu LC, Yau AC. The cervical spine after halo-pelvic traction. An analysis of the complications of 83 patients[J]. J Bone Joint Surg Br, 1980,62B(2):158-161.
[16] 赵聚峰, 杜志伟. 严重脊柱侧后凸畸形头盆环支撑牵引预治疗31例体会[J]. 实用骨科杂志, 2005,11(3):265-266.
[17] 田慧中, 吕霞, 马原. 头盆环牵引全脊柱截骨内固定治疗重度脊柱弯曲[J]. 中国矫形外科杂志, 2007,15(3):167-172.
[18] Rozario RA, Stein BM. Complications of halo-pelvic traction. Case report[J]. J Neurosurg, 1976,45(6):716-718.
doi: 10.3171/jns.1976.45.6.0716 pmid: 978245
[19] Ransford AO, Manning CW. Complications of halo-pelvic distraction for scoliosis[J]. J Bone Joint Surg Br, 1975,57(2):131-137.
pmid: 1141278
[20] Ma JK, Ning LH. Posterior instrumentation and spondylodesis for scoliosis under halo-pelvic distraction with local anesthesia[J]. Zhonghua Wai Ke Za Zhi, 1987,25(7):390-393, 444.
pmid: 3677941
[21] Zielke K, Pellin B. Halo-pelvic traction. How to reduce its dangers by simplifying its use[J]. Z Orthop Ihre Grenzgeb, 1974,112(2):351-354.
pmid: 4276749
[22] Tredwell SJ, O’Brien JP. Avascular necrosis of the proximal end of the dens. A complication of halo-pelvic distraction[J]. J Bone Joint Surg Am, 1975,57(3):332-336.
pmid: 1123386
[23] Tredwell SJ, O’Brien JP. Apophyseal joint degeneration in the cervical spine following halo-pelvic distraction[J]. Spine (Phila Pa 1976), 1980,5(6):497-501.
doi: 10.1097/00007632-198011000-00002
[24] Dove J, Hsu LC, Yau AC. Spontaneous cervical spinal fusion. A complication of halo-pelvic traction[J]. Spine (Phila Pa 1976), 1981,6(1):45-48.
doi: 10.1097/00007632-198101000-00008
[25] Ransford AO, Manning CW. Halo-pelvic apparatus: peritoneal penetration by pelvic pins[J]. J Bone Joint Surg Br, 1978,60B(3):404-405.
[26] O’Brien JP, Yau AC, Smith TK, et al. Halo pelvic traction. A preliminary report on a method of external skeletal fixation for correcting deformities and maintaining fixation of the spine[J]. J Bone Joint Surg Br, 1971,53(2):217-229.
pmid: 5578217
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