Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Spine Deform. 2021 May;9(3):769-776. doi: 10.1007/s43390-020-00268-1. Epub 2021 Jan 19.
Intraoperative traction has shown improved curve correction in neuromuscular scoliosis surgery. It is found to be superior to anterior release in terms of correction of both main curve and pelvic obliquity. No previous study has examined the effect of intraoperative traction in patients without pelvic fixation.
This retrospective study included 40 non-ambulatory (GMFCS 4 or above) patients with neuromuscular scoliosis undergoing surgery with bilateral segmental pedicle screw instrumentation to L5. Twenty-two consecutive patients had intraoperative Gardner-Wells tongs and skin traction (traction group), while the remaining did not (non-traction group). Inclusion criteria were minimum 2-year follow-up, complete medical records and radiographs. Main curve (MC), pelvic obliquity (POB), T1 tilt, kyphosis, rotation, coronal and sagittal balance and preoperative bending radiographs were measured and analyzed in all patients.
Both groups demonstrated roughly 60% MC correction. Preoperative MC was larger in the traction group [97° (49-126) vs. 83° (40-134); P = 0.03]. The measured correction index was almost twice as large in the traction group (1.9 vs. 1.1; P = 0.001). Mean [IQR] 2-year POB was 14° [7-40] in the traction group compared to 16° [4-60] in the non-traction group (P = 0.59). Eleven patients (50%) in the traction group compared to only four (22%) in the non-traction group had a POB within 10° at 2-year follow up (RR: 2.1; 95% CI 0.8-5.2). We found no difference in kyphosis or remaining radiographic parameters. No traction-related complications were recorded.
In patients with neuromuscular scoliosis undergoing instrumented fusion to the L5, we found that intraoperative traction increased the degree of MC correction and patients were more likely to achieve POB below 10° without any effects on sagittal parameters or without any detectable significant reduction on rotation.
术中牵引已显示出在神经肌肉性脊柱侧凸手术中改善曲线矫正的效果。与前路松解相比，它在主曲线和骨盆倾斜的矫正方面均表现出优势。先前没有研究检查过术中牵引对没有骨盆固定的患者的影响。
这项回顾性研究纳入了 40 例非步行（GMFCS 4 级或以上）神经肌肉性脊柱侧凸患者，这些患者均接受双侧节段性椎弓根螺钉内固定术至 L5。22 例连续患者行术中 Gardner-Wells 丁字鞋和皮肤牵引（牵引组），而其余患者未行牵引（非牵引组）。纳入标准为至少 2 年随访、完整的病历和影像学资料。所有患者均测量和分析主曲线（MC）、骨盆倾斜（POB）、T1 倾斜、后凸、旋转、冠状面和矢状面平衡以及术前弯曲位 X 线片。
两组患者的 MC 均矫正约 60%。牵引组患者 MC 术前较大[97°（49-126）比 83°（40-134）；P = 0.03]。牵引组的测量矫正指数几乎是对照组的两倍（1.9 比 1.1；P = 0.001）。牵引组患者 2 年时平均[IQR]POB 为 14°[7-40]，而非牵引组为 16°[4-60]（P = 0.59）。在牵引组中有 11 例（50%）患者，而非牵引组仅有 4 例（22%）患者的 POB 在 2 年随访时在 10°以内（RR：2.1；95%CI 0.8-5.2）。我们未发现后凸或其他影像学参数存在差异。未记录到与牵引相关的并发症。
在接受 L5 节段性器械融合的神经肌肉性脊柱侧凸患者中，我们发现术中牵引增加了 MC 的矫正程度，并且患者更有可能实现 POB 小于 10°，而对矢状面参数无任何影响，也没有明显降低旋转。
