Spine Surgery Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, China.
Department of Orthopaedic Surgery, the 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
BMC Musculoskelet Disord. 2021 Jan 23;22(1):106. doi: 10.1186/s12891-021-03953-y.
The severe rigid deformity patients with pulmonary dysfunction could not tolerate complicated corrective surgery. Preoperative traction are used to reduce the curve magnitude and improve the pulmonary function before surgery, including halo-gravity traction (HGT) and halo-pelvic traction (HPT). The present study aimed to retrospectively compare the radiographic, pulmonary and clinical outcomes of preoperative HGT and HPT in severe rigid spinal deformity with respiratory dysfunction.
81 cases of severe rigid kyphoscoliosis treated with preoperative traction prior to corrective surgery for spinal deformity between 2016 and 2019 were retrospectively reviewed. Two patient groups were compared, HPT group (N = 30) and HGT group (N = 51). Patient demographics, coronal and sagittal Cobb angles and correction rates, pulmonary function, traction time, osteotomy grade, and postoperative neurological complications were recorded for all cases.
The coronal Cobb angle was corrected from 140.67 ± 2.63 to a mean of 120.17 ± 2.93° in the HGT group, and from 132.32 ± 4.96 to 87.59 ± 3.01° in the HPT group (mean corrections 15.33 ± 1.53 vs. 34.86 ± 3.11 %) (P = 0.001). The mean major sagittal curve decreased from 134.28 ± 3.77 to 113.03 ± 4.57° in the HGT group and from 129.60 ± 8.45 to 65.61 ± 7.86° in the HPT group (P < 0.001); the mean percentage corrections were 16.50 ± 2.13 and 44.09 ± 9.78 % (P < 0.001). A significant difference in the pulmonary function test results was apparent between the two groups; the mean improvements in the FVC% of the HGT and HPT groups were 6.76 ± 1.85 and 15.6 ± 3.47 % (P = 0.024). The HPT group tended to exhibit more FEV% improvement than the HGT group, but the difference was not significant (5.15 ± 2.27 vs. 11.76 ± 2.22 %, P = 0.91).
Patients with severe rigid kyphoscoliosis who underwent preoperative HPT exhibited better radiographic correction of the deformity, and pulmonary function, and required fewer osteotomies compared to the HGT group. Thus, HPT may be useful for severe rigid spinal deformity patients with pulmonary dysfunction.
患有肺功能障碍的严重僵硬畸形患者无法耐受复杂的矫正手术。术前牵引用于在手术前降低曲线幅度并改善肺功能，包括 Halo-Gravity 牵引（HGT）和 Halo-Pelvic 牵引（HPT）。本研究旨在回顾性比较术前 HGT 和 HPT 在伴有呼吸功能障碍的严重僵硬脊柱畸形患者中的影像学、肺功能和临床结果。
回顾性分析 2016 年至 2019 年间接受术前牵引治疗的 81 例严重僵硬性脊柱后凸畸形患者。比较两组患者，HPT 组（N=30）和 HGT 组（N=51）。记录所有病例的患者人口统计学、冠状和矢状 Cobb 角和矫正率、肺功能、牵引时间、截骨分级和术后神经并发症。
HGT 组的冠状 Cobb 角从 140.67±2.63°矫正至平均 120.17±2.93°，HPT 组从 132.32±4.96°矫正至 87.59±3.01°（平均矫正 15.33±1.53%比 34.86±3.11%）（P=0.001）。HGT 组的主要矢状曲线平均减少 134.28±3.77°至 113.03±4.57°，HPT 组从 129.60±8.45°减少至 65.61±7.86°（P<0.001）；平均矫正百分比分别为 16.50±2.13%和 44.09±9.78%（P<0.001）。两组之间的肺功能测试结果明显不同；HGT 和 HPT 组的 FVC%平均改善分别为 6.76±1.85%和 15.6±3.47%（P=0.024）。HPT 组的 FEV%改善趋势优于 HGT 组，但差异无统计学意义（5.15±2.27%比 11.76±2.22%，P=0.91）。
与 HGT 组相比，术前接受 HPT 的严重僵硬性脊柱后凸患者在畸形的影像学矫正、肺功能和所需截骨数量方面表现更好。因此，HPT 可能对伴有肺功能障碍的严重僵硬性脊柱畸形患者有用。
