Watanabe Kei, Lenke Lawrence G, Bridwell Keith H, Kim Yongjung J, Hensley Marsha, Koester Linda
Department of Orthopaedic Surgery, Niigata University Medical and Dental General Hospital, Niigata, Japan.
J Orthop Sci. 2010 Nov;15(6):720-30. doi: 10.1007/s00776-010-1523-8. Epub 2010 Nov 26.
There have been no standardized surgical options for severe scoliotic curvatures ≥100°. Halo-gravity traction is a viable option for surgical treatment of severe scoliosis. The aim of this study was to evaluate the efficacy and safety of perioperative halo-gravity traction for scoliosis curves ≥100° with respect to radiographic outcomes and clinical complications.
A total of 21 scoliosis patients with ≥100° curves (average 118.7°; range 100°-158°) with a minimum 2-year follow-up (average 41.8 months; range 24.0-97.0 months) who underwent spinal instrumented fusion using perioperative halo-gravity traction were analyzed. Diagnoses were neuromuscular scoliosis (n = 10), idiopathic (n = 9), and congenital (n = 2). In all, 15 patients were treated by the anterior release procedure followed by final posterior fusion and 6 patients by posterior fusion alone. Six patients had only preoperative traction preceding posterior fusion alone, 6 patients only staged traction between anterior release and final posterior fusion, and 9 patients had both preoperative traction preceding anterior release and staged traction preceding final posterior fusion. The average overall traction period in all patients was 67 days (range 10-78 days).
Radiographic outcomes demonstrated 51.3% correction of the major Cobb angle, 40 mm correction of apical vertebral translation, 76 mm increase of T1-S1 length, and 20.7% increase of space available for lungs at the ultimate follow-up (all comparisons P < 0.05). Preoperative traction demonstrated 27.5% correction of the major curve Cobb angle, 51.5 mm increase of T1-S1 length, 14.9% increase of space available for the lungs (all comparisons P < 0.05). Staged traction after anterior release demonstrated 37.2% correction of the major curve Cobb angle, 26.1 mm correction of apical vertebral translation, 56.5 mm increase of T1-S1 length, 14.2% increase of space available for the lungs (all comparisons P < 0.05). There were only two patients with a pin-site problem, and one required débridement. There were no neurological deficits or clinical complications.
Scoliosis patients with ≥100° curves can be managed successfully by corrective fusion surgery concomitant with perioperative halo-gravity traction without significant complications.
对于≥100°的严重脊柱侧弯尚无标准化的手术方案。头环重力牵引是严重脊柱侧弯手术治疗的一种可行选择。本研究的目的是评估围手术期头环重力牵引治疗≥100°脊柱侧弯在影像学结果和临床并发症方面的疗效及安全性。
分析了21例接受围手术期头环重力牵引并进行脊柱器械融合且随访至少2年（平均41.8个月；范围24.0 - 97.0个月）的脊柱侧弯患者，其侧弯角度≥100°（平均118.7°；范围100° - 158°）。诊断包括神经肌肉型脊柱侧弯（n = 10）、特发性（n = 9）和先天性（n = 2）。总共15例患者先行前路松解术，然后进行最终的后路融合，6例患者仅行后路融合。6例患者仅在单纯后路融合前进行术前牵引，6例患者仅在前路松解与最终后路融合之间进行分期牵引，9例患者在前路松解前进行术前牵引且在最终后路融合前进行分期牵引。所有患者的平均总牵引期为67天（范围10 - 78天）。
影像学结果显示，在末次随访时主 Cobb 角矫正51.3%，顶椎平移矫正40 mm，T1 - S1长度增加76 mm，肺可用空间增加20.7%（所有比较P < 0.05）。术前牵引显示主弯 Cobb 角矫正27.5%，T1 - S1长度增加51.5 mm，肺可用空间增加14.9%（所有比较P < 0.05）。前路松解后的分期牵引显示主弯 Cobb 角矫正37.2%，顶椎平移矫正26.1 mm，T1 - S1长度增加56.5 mm，肺可用空间增加14.2%（所有比较P < 0.05）。仅2例患者出现针道问题，其中1例需要清创。无神经功能缺损或临床并发症。
≥100°侧弯的脊柱侧弯患者可通过矫正融合手术联合围手术期头环重力牵引成功治疗，且无明显并发症。
