Wang Yingsong, Xie Jingming, Zhao Zhi, Li Tao, Zhang Yin, Bi Ni, Shi Zhiyue, Cai Yunhua, Zhang Yuhao
Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People's Republic of China.
Eur Spine J. 2016 Mar;25(3):687-97. doi: 10.1007/s00586-014-3752-6. Epub 2015 Jan 10.
Severe rigid spine deformity with sharp curve can be effectively corrected by posterior vertebral column resection (PVCR). Meanwhile, high risk of this procedure also has been recognized generally. The aim of this study is to review and evaluate the role of preoperative skull-femoral traction prior to PVCR for extremely severe rigid spinal deformity with sharp angular curve >150°.
Twelve cases with extremely severe rigid deformities and sharp curves were treated by skull-femoral traction before operation. For them, the mean preoperative major scoliotic curve and kyphosis were 153° (110°-168°) and 109° (61°-180°). Continuous skull-femoral traction in supine position was started 4 weeks before operation. In the process of traction, tolerance, neurologic status, deformity changes, etc., were reviewed and documented for analysis. PVCR were performed in all these patients for final and main correction.
The final traction force in the 12 cases was 63% of body weight. After 4-week traction, the main scoliotic curve and kyphosis were decreased by 34 and 31%. In 1 week, main scoliotic curve and kyphosis were decreased by 19 and 15%. In 2 weeks, the major scoliosis curve was decreased by 11%, but kyphosis was unexpectedly increased by 4%. Deformity in the last 2 weeks was less significant than the first 2 weeks. After PVCR, the main scoliotic curve and kyphosis were improved 69 and 66%. No permanent neurological damage occurred.
Preoperative skull-femoral traction effectively mitigates the neurological risks of PVCR for extremely severe rigid spinal deformity with sharp curve. During traction, scoliosis can be improved more significantly and easily than kyphosis.
严重僵硬脊柱畸形伴锐利弯曲可通过后路脊柱全椎体切除术（PVCR）有效矫正。同时，该手术的高风险也已得到普遍认可。本研究的目的是回顾和评估术前颅骨 - 股骨牵引在PVCR治疗角度大于150°的极其严重僵硬脊柱畸形中的作用。
12例极其严重僵硬畸形且伴有锐利弯曲的患者在术前接受了颅骨 - 股骨牵引。他们术前主要脊柱侧凸曲线和后凸畸形的平均值分别为153°（110° - 168°）和109°（61° - 180°）。术前4周开始在仰卧位进行持续颅骨 - 股骨牵引。在牵引过程中，对耐受性、神经状况、畸形变化等进行回顾并记录以进行分析。所有这些患者均接受PVCR进行最终和主要矫正。
12例患者的最终牵引力量为体重的63%。4周牵引后，主要脊柱侧凸曲线和后凸畸形分别减少了34%和31%。1周时，主要脊柱侧凸曲线和后凸畸形分别减少了19%和15%。2周时，主要脊柱侧凸曲线减少了11%，但后凸畸形意外增加了4%。最后2周的畸形改善不如前2周明显。PVCR术后，主要脊柱侧凸曲线和后凸畸形分别改善了69%和66%。未发生永久性神经损伤。
术前颅骨 - 股骨牵引有效降低了PVCR治疗伴有锐利弯曲的极其严重僵硬脊柱畸形的神经风险。在牵引过程中，脊柱侧凸比后凸畸形改善更显著、更容易。
