Qiao Jun, Xiao Lingyan, Xu Leilei, Liu Zhen, Sun Xu, Qian Bangping, Zhu Zezhang, Qiu Yong
Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, China.
Intensive care unit, the Second Hospital of Nanjing, Southeast University, Nanjing, China.
BMC Musculoskelet Disord. 2018 Aug 2;19(1):277. doi: 10.1186/s12891-018-2207-3.
It is a great challenge for spine surgeons to correct severe rigid scoliosis. We developed a three- staged correction (one stage posterior release and screw placement, two stage skull-femoral traction and three stage posterior instrumentation) for adult severe scoliosis. The objective of this study is to investigate safety and efficacy of a three- staged correction for adult severe scoliosis.
A retrospective review was performed for patients with severe scoliosis receiving three- staged correction (one stage posterior release and screw placement, two stage skull-femoral traction and three stage posterior instrumentation) from June 2001 to October 2014. The inclusion criteria were as follows: [1] age more than 18 years; [2] main curve larger than 90°; [3] a minimum 2-year follow-up. Patients were excluded if they had a history of surgery or anterior release or receiving three column osteotomies.
A total of 63 patients were included (37 female and 26 male), with a mean age of 22.7 years (range: 18-30 years) and follow-up of 42.6 months (range: 24-108 months). The aetiology was congenital in 27 patients, neuromuscular in 18, idiopathic in 11, neurofibromatosis-1 in 4 and Marfan syndrome in 3. The mean traction weight was 28.4 kg (range: 18-32 kg), equal to 57.2% of patients' body weight (range: 42.7-72.3%). The mean traction time was 22.7 days (range: 12-44 days). Postoperative correction rate was 55% (range: 38-78%) for scoliosis and 51% (range: 32-75%) for kyphosis. Contribution of traction to correction was 51% (range: 36-70%) for scoliosis and was 43% (range: 34-55%) for kyphosis.
Three- staged correction (one stage posterior release and screw placement, two stage skull-femoral traction and three stage posterior instrumentation) could effectively correct adult severe scoliosis. The incidence of complications of skull-femoral traction was not low, but transient and could be successfully managed.
对于脊柱外科医生而言，矫正严重僵硬性脊柱侧弯是一项巨大挑战。我们针对成人严重脊柱侧弯研发了一种三阶段矫正方法（第一阶段后路松解及螺钉置入，第二阶段头-股牵引，第三阶段后路内固定）。本研究的目的是探讨三阶段矫正方法治疗成人严重脊柱侧弯的安全性和有效性。
对2001年6月至2014年10月期间接受三阶段矫正方法（第一阶段后路松解及螺钉置入，第二阶段头-股牵引，第三阶段后路内固定）治疗的严重脊柱侧弯患者进行回顾性研究。纳入标准如下：[1]年龄大于18岁；[2]主弯大于90°；[3]至少随访2年。有手术史、前路松解史或接受过三柱截骨术的患者被排除。
共纳入63例患者（女性37例，男性26例），平均年龄22.7岁（范围：18 - 30岁），随访时间42.6个月（范围：24 - 108个月）。病因方面，先天性27例，神经肌肉性18例，特发性11例，神经纤维瘤病1型4例，马方综合征3例。平均牵引重量为28.4 kg（范围：18 - 32 kg），相当于患者体重的57.2%（范围：42.7 - 72.3%）。平均牵引时间为22.7天（范围：12 - 44天）。脊柱侧弯术后矫正率为55%（范围：38 - 78%），后凸畸形术后矫正率为51%（范围：32 - 75%）。牵引对脊柱侧弯矫正的贡献率为51%（范围：36 - 70%），对后凸畸形矫正的贡献率为43%（范围：34 - 55%）。
三阶段矫正方法（第一阶段后路松解及螺钉置入，第二阶段头-股牵引，第三阶段后路内固定）能有效矫正成人严重脊柱侧弯。头-股牵引的并发症发生率虽不低，但为一过性，且可成功处理。
