Orthopaedic Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Eur Spine J. 2012 Jun;21(6):1091-8. doi: 10.1007/s00586-011-2111-0. Epub 2011 Dec 13.
Despite the advantages of modern instrumentation techniques, the treatment of severe rigid idiopathic scoliosis could be very demanding. Traction can provide better, safer correction and minimize complications related to forceful intra-operative maneuvers; however, several side effects are associated with prolonged periods of traction. The aim of this work is to review the clinical and radiographic results of limited perioperative halo-gravity traction in severe rigid curves analyzing its efficacy, advantages and possible complications and comparing it to classic two staged corrections performed without traction.
A retrospective case control study including 47 adolescents with severe rigid idiopathic scoliosis divided into two groups; a consecutive series of 21 patients who had a three-staged correction by an anterior release, 2 weeks of halo-gravity traction then posterior instrumentation (TRN group); compared to an earlier series of 26 consecutive patients treated without traction (SAP group). The average age was 18 years + 1 month and 16 years + 2 months, respectively. The average preoperative dorsal and lumbar curves for (TRN) group were 106.5° and 87°, respectively, and for (SAP) group were 102° and 81°, respectively.
Patients were followed up for an average of 6 years (range 3-8 years). A significantly better correction was achieved in (TRN) group (average 59%) compared to (SAP) group (average 47%). At final follow-up, the loss of correction had an average of 8° for (TRN) group and 11° for (SAP) group. A shorter hospital stay was found in (SAP) group; a shorter operative time was found in (TRN) group and there was no significant difference in blood loss, early or delayed complications.
Limited halo-gravity traction is an efficient, safe modality in the treatment of severe rigid adolescent scoliosis. The application of gradual traction over a limited period of 2 weeks led to better correction, shorter operative time with no significant complications.
尽管现代仪器技术有优势，但严重僵硬特发性脊柱侧凸的治疗可能极具挑战性。牵引可以提供更好、更安全的矫正效果，并最大限度地减少与强力术中操作相关的并发症；然而，长时间的牵引会带来一些副作用。本研究旨在回顾严重僵硬性曲线患者在围手术期行有限期 halo-gravity 牵引的临床和影像学结果，分析其疗效、优点和可能的并发症，并将其与无牵引的经典两阶段矫正进行比较。
回顾性病例对照研究，纳入 47 名患有严重僵硬特发性脊柱侧凸的青少年，分为两组；一组为 21 例连续患者，采用前路松解、2 周 halo-gravity 牵引然后后路器械固定（TRN 组）进行三期矫正；另一组为 26 例连续患者，采用无牵引的早期系列治疗（SAP 组）。平均年龄分别为 18 岁+1 个月和 16 岁+2 个月。TRN 组术前平均胸腰段后凸和侧凸分别为 106.5°和 87°，SAP 组分别为 102°和 81°。
患者平均随访 6 年（3-8 年）。TRN 组的矫正效果明显优于 SAP 组（平均 59%对 47%）。最终随访时，TRN 组的矫正丢失平均为 8°，SAP 组为 11°。SAP 组的住院时间较短；TRN 组的手术时间较短，两组的出血量、早期或迟发性并发症无显著差异。
有限 halo-gravity 牵引是治疗严重僵硬性青少年脊柱侧凸的有效、安全方法。在 2 周的有限时间内施加逐渐牵引可实现更好的矫正效果，缩短手术时间，且无明显并发症。
