Halo 重力牵引在重度早发性脊柱畸形治疗中的应用。
The Use of Halo Gravity Traction in the Treatment of Severe Early Onset Spinal Deformity.
机构信息
Hospital for Special Surgery, New York, NY.
FOCOS Orthopaedic Hospital, Accra, Ghana.
出版信息
Spine (Phila Pa 1976). 2019 Jul 15;44(14):E841-E845. doi: 10.1097/BRS.0000000000002997.
STUDY DESIGN
Retrospective Review of Prospective cohort.
OBJECTIVE
To describe the feasibility of preoperative halo gravity traction (HGT) with subsequent growing rod/guided growth (GR/GG) placement in early onset spinal deformity (EOSD).
SUMMARY OF BACKGROUND DATA
In children with severe EOSD, primary implantation of GR/GG constructs is not always possible. We describe a staged protocol with preoperative HGT followed by GR/GG implantation.
METHODS
EOSD patients treated with HGT prior to GR/GG implantation were included. HGT used traction up to 50% body weight for 4 to 29 weeks. Pulmonary function tests (PFTs) were performed before and after HGT. Coronal Cobb (CC) and Sagittal Cobb (SC) angles were measured on the Pre-HGT, Post-HGT and 6 week postop x-rays.
RESULTS
Thirty patients were included. Average age at GR/GG implantation was 9 years. Most cases (n = 24, 80%) were idiopathic. Most pts had kyphoscoliosis (n = 16, 53.3%). Pre-HGT CC averaged 112 ± 22° and SC averaged 106 ± 26°. CC and SC improved 29% after HGT. There was a significant improvement in body mass index following HGT. CC improved further to 70 ± 14° (36% vs. pre-HGT) and SC to 63 ± 21° (41%) with GR/GG placement. HGT-related complications occurred in nine patients (30%); eight pin site infections, one cranial abscess. Most HGT complications were managed with local pin care and oral antibiotics. Halo revision was required in two pts (6.7%). There was no change in PFTs with HGT (P > 0.05). Averagely, 14 levels were spanned during GR/GG implantation; two patients required vertebral column resection. Surgical complications occurred in nine (30%) patients. At average 16 month follow-up, seven patients (23.3%) required reoperation.
CONCLUSION
Preoperative HGT can make severe EOSD curves amenable to GR/GG implantation. HGT results in ∼30% correction with improvement to ∼35-40% following GR/GG. HGT has a 30% complication rate but most are pin-site infections managed with pin-site care and oral antibiotics; 6.7% of patients require revision.
LEVEL OF EVIDENCE
研究设计
前瞻性队列的回顾性研究。
目的
描述早期发病脊柱畸形（EOSD）患者术前使用 halo 重力牵引（HGT）联合后续使用生长棒/引导生长（GR/GG）的可行性。
背景资料概要
对于严重的 EOSD 患儿，并非总能直接植入 GR/GG 器械。我们描述了一种分期方案，包括术前 HGT 和随后植入 GR/GG。
方法
我们纳入了接受 HGT 治疗后再植入 GR/GG 的 EOSD 患者。HGT 采用 50%体重的牵引力，持续 4 至 29 周。在 HGT 前后进行肺功能测试（PFT）。在术前、术后和术后 6 周的 X 线片上测量冠状 Cobb（CC）和矢状 Cobb（SC）角度。
结果
共纳入 30 例患者。GR/GG 植入时的平均年龄为 9 岁。大多数病例（n=24，80%）为特发性。大多数患者存在脊柱后凸侧凸（n=16，53.3%）。术前 CC 平均为 112±22°，SC 平均为 106±26°。HGT 后 CC 改善 29%。HGT 后体重指数显著改善。CC 进一步改善至 70±14°（与术前相比改善 36%），SC 改善至 63±21°（与术前相比改善 41%），随后植入 GR/GG。9 例患者（30%）出现 HGT 相关并发症，包括 8 例针道感染和 1 例颅骨脓肿。大多数 HGT 并发症通过局部针道护理和口服抗生素得到处理。2 例患者（6.7%）需要 Halo 翻修。HGT 对 PFT 无影响（P＞0.05）。平均在 GR/GG 植入时覆盖 14 个节段，2 例患者需要行脊柱全长切除。9 例（30%）患者发生手术并发症。在平均 16 个月的随访中，7 例患者（23.3%）需要再次手术。
结论
术前 HGT 可使严重的 EOSD 曲线易于接受 GR/GG 植入。HGT 可使曲线矫正约 30%，随后植入 GR/GG 后进一步矫正约 35-40%。HGT 的并发症发生率为 30%，但大多数是针道感染，通过针道护理和口服抗生素即可处理；6.7%的患者需要翻修。
证据等级
4。
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