British Columbia Children's Hospital, Vancouver, BC, Canada.
Johns Hopkins Children's Center, Baltimore, MD, USA.
Spine Deform. 2021 Nov;9(6):1549-1557. doi: 10.1007/s43390-021-00369-5. Epub 2021 Jun 16.
Determine the efficacy of intraoperative traction (IOT) on curve correction in AIS.
A prospective, multicenter, longitudinal database identified patients with major thoracic AIS (Lenke 1-4) treated with surgery using IOT and follow-up of 2 years. These cases were matched to comparable cases treated without traction (non-IOT). All patients were treated with single-stage posterior only surgery with pedicle screw constructs. Perioperative, radiographic and clinical outcome data at 2 years post-op were compared between the groups.
104 cases treated with IOT were matched to 104 treated without IOT. Operating room time was significantly greater in the IOT group (339 vs. 306 min, p = < 0.001). Neuromonitoring alerts were more frequent in the IOT group (23% vs. 5%, p < 0.001). There were no postoperative neurological deficits in either group. The IOT group showed significantly greater MT curve correction (IOT 71% vs. non-IOT 66.7%, p < 0.003), with the effect most pronounced in curves > 70° (IOT 72% vs. non-IOT 64%, p = 0.04). IOT was associated with a significant reduction in 2D T5-T12 kyphosis measurements (IOT - 6.5° vs non-IOT + 0.48°, p < 0.001), yet significant improvements in estimated 3D thoracic kyphosis were made in both groups, with the non-IOT group making greater improvement when compared to the IOT group (IOT + 18.1° vs. non-IOT + 22.3° vs., p = 0.008).
IOT is associated with modestly enhanced coronal deformity correction. Surgeons should be aware of the increased rates of neuromonitoring alerts when using this technique and its affect on the sagittal profile. Given this IOT may be best suited to larger curves.
确定术中牵引（IOT）对 AIS 中曲线矫正的疗效。
前瞻性、多中心、纵向数据库确定了接受 IOT 治疗和随访 2 年的主要胸段 AIS（Lenke 1-4）患者。这些病例与未接受牵引（非 IOT）治疗的可比病例相匹配。所有患者均采用后路一期单纯椎弓根螺钉固定术治疗。比较两组患者术后 2 年的围手术期、影像学和临床结果数据。
104 例接受 IOT 治疗的病例与 104 例未接受 IOT 治疗的病例相匹配。IOT 组的手术室时间明显更长（339 分钟 vs. 306 分钟，p<0.001）。IOT 组的神经监测报警更频繁（23% vs. 5%，p<0.001）。两组均无术后神经功能缺损。IOT 组的 MT 曲线矫正明显更大（IOT 71% vs. 非 IOT 66.7%，p<0.003），在曲线>70°时效果最明显（IOT 72% vs. 非 IOT 64%，p=0.04）。IOT 与 2D T5-T12 后凸测量值显著降低相关（IOT-6.5° vs. 非 IOT+0.48°，p<0.001），但两组的估计 3D 胸椎后凸均有显著改善，非 IOT 组的改善程度大于 IOT 组（IOT+18.1° vs. 非 IOT+22.3°，p=0.008）。
IOT 与适度增强的冠状面畸形矫正相关。当使用该技术时，外科医生应意识到神经监测报警的发生率增加及其对矢状面的影响。鉴于 IOT 可能最适合较大的曲线。
3 级。
