Nemani Venu M, Kim Han Jo, Bjerke-Kroll Benjamin T, Yagi Mitsuru, Sacramento-Dominguez Cristina, Akoto Harry, Papadopoulos Elias C, Sanchez-Perez-Grueso Francisco, Pellise Ferran, Nguyen Joseph T, Wulff Irene, Ayamga Jennifer, Mahmud Rufai, Hodes Richard M, Boachie-Adjei Oheneba
*Spine and Scoliosis Surgery, Hospital for Special Surgery, New NY †Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan ‡Spine Unit, Hospital Ruber Internacional, Madrid, Spain §Department of Neurosurgery, Korle Bu Teaching Hospital, Accra, Ghana ¶2nd Department of Orthopaedics, University of Athens School of Medicine, Athens, Greece ‖Department of Orthopedic Surgery, Spine Unit, Hospital La Paz, Madrid, Spain **Spine Unit, Servicio de COT, Hospital Vall d'Hebron, Barcelona, Spain ††Research Department, FOCOS Hospital, Accra, Ghana; and ‡‡AJJDC, Addis Ababa, Ethiopia.
Spine (Phila Pa 1976). 2015 Feb 1;40(3):153-61. doi: 10.1097/BRS.0000000000000675.
Retrospective analysis of a prospectively collected single-center database.
We describe a modified halo-gravity traction (HGT) protocol for patients with severe spinal deformities in West Africa, and assess the clinical and radiographic outcomes.
Three-column osteotomies are frequently used in the correction of severe spinal deformities; however, these can be associated with high complication rates and significant risk for neurological injury. Preoperative traction is one modality used to obtain a partial correction prior to definitive fusion. Low numbers and variability of traction protocols, however, have limited previous reports of sustained HGT.
All patients who underwent HGT in Ghana from April 2012 to August 2013 were reviewed. HGT was started at 20% body weight and increased by 10% per week until 50% body weight was reached by 4 weeks or thereafter as tolerated. Demographic variables, operative data, radiographic parameters, and health-related quality of life scores were collected. A deformity reduction index was calculated at each time point by summing the scoliosis and abnormal kyphosis for each patient and reported as a percentage of the preoperative deformity.
Twenty-nine patients underwent HGT for an average 107 days prior to definitive posterior spinal fusion (24 patients) or placement of growing rods (5 patients). The major curve improved from an average 131° to 90° (31%) after HGT, and to an average 57° (56%) postoperatively. Pure kyphotic curves were rigid (flexibility 22% after traction), with a correction index of 3.88, which is similar to historical controls. Deformity correction with HGT plateaued at 63 days. Overall Scoliosis Research Society-22 questionnaire scores improved significantly pretraction versus postoperatively, but there was no change after traction versus before traction. There were 11 pin tract infections, with no neurological complications.
HGT is a safe method to partially correct severe spinal deformities prior to a definitive procedure, and may reduce the need for higher risk 3-column osteotomies. Importantly, kyphosis secondary to infection with spontaneous apical ankylosis is relatively resistant to HGT.
对前瞻性收集的单中心数据库进行回顾性分析。
我们描述了一种针对西非严重脊柱畸形患者的改良头环重力牵引（HGT）方案，并评估其临床和影像学结果。
三柱截骨术常用于矫正严重脊柱畸形；然而，这些手术可能伴有高并发症发生率和严重神经损伤风险。术前牵引是在最终融合前用于获得部分矫正的一种方法。然而，牵引方案的数量少且存在差异，限制了以往关于持续HGT的报道。
对2012年4月至2013年8月在加纳接受HGT的所有患者进行回顾。HGT起始重量为体重的20%，每周增加10%，直至4周时达到体重的50%，或此后根据耐受情况增加。收集人口统计学变量、手术数据、影像学参数和健康相关生活质量评分。通过将每位患者的脊柱侧凸和异常后凸相加，在每个时间点计算畸形矫正指数，并报告为术前畸形的百分比。
29例患者在最终后路脊柱融合术（24例患者）或植入生长棒（5例患者）之前平均接受了107天的HGT。主要弯曲度在HGT后从平均131°改善至90°（改善31%），术后平均改善至57°（改善56%）。单纯后凸曲线僵硬（牵引后柔韧性为22%），矫正指数为3.88，与历史对照相似。HGT的畸形矫正在63天时趋于平稳。总体而言，脊柱侧凸研究学会-22问卷评分在牵引前与术后有显著改善，但牵引后与牵引前相比无变化。有11例针道感染，无神经并发症。
HGT是在确定性手术前部分矫正严重脊柱畸形的一种安全方法，可能减少对高风险三柱截骨术的需求。重要的是，继发于感染并伴有自发性顶椎融合的后凸对HGT相对抵抗。
4级。
