Shengfa Pan, Hongyu Chen, Yu Sun, Fengshan Zhang, Li Zhang, Xin Chen, Yinze Diao, Yanbin Zhao, Feifei Zhou
Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.
Front Surg. 2023 Jan 6;9:1090199. doi: 10.3389/fsurg.2022.1090199. eCollection 2022.
This study aimed to investigate a new noninvasive traction method on the treatment of severe cervical kyphotic deformity.
The clinical data of patients with severe cervical kyphosis (Cobb > 40°) treated in Peking University Third Hospital from March 2004 to March 2020 were retrospectively summarized. 46 cases were enrolled, comprising 27 males and 19 females. Fifteen patients underwent skull traction, and 31 patients underwent suspensory traction. Among them, seven used combined traction after one week of suspensory traction. Bedside lateral radiographs were taken every two or three days during traction. The cervical kyphosis angle was measured on lateral radiographs in and extended position at each point in time. The correction rate and evaluated Japanese Orthopedic Association (JOA) scoring for the function of the spinal cord were also measured. The data before and after the operation were compared with paired sample t-test or Wilcoxon signed-rank test.
No neurological deterioration occurred during the skull traction and the cervical suspensory traction. There were 12 patients with normal neurological function, and the JOA score of the other 34 patients improved from 11.5 ± 2.8 to 15.4 ± 1.8 at the end of follow up ( < 0.05). The average kyphotic Cobb angle was 66.1° ± 25.2, 28.7° ± 20.1 and 17.4° ± 25.7 pre-traction, pre-operative, and at the final follow-up, respectively ( < 0.05). The average correction rate of skull traction and suspensory traction was 34.2% and 60.6% respectively. Among these, the correction rate of patients with simple suspensory traction was 69.3%. For patients with a correction rate of less than 40% by suspensory traction, combined traction was continued, and the correction rates after suspensory traction and combined traction were 30.7% and 67.1% respectively.
Pre-correction by cervical suspensory traction can achieve good results for severe cervical kyphotic deformity, with no wound and an easy process. Combined traction is effective for supplemental traction after suspensory traction.
本研究旨在探讨一种新型非侵入性牵引方法治疗严重颈椎后凸畸形的效果。
回顾性总结2004年3月至2020年3月在北京大学第三医院接受治疗的严重颈椎后凸畸形（Cobb角>40°）患者的临床资料。共纳入46例患者，其中男性27例，女性19例。15例行颅骨牵引，31例行悬吊牵引。其中7例在悬吊牵引1周后采用联合牵引。牵引期间每2至3天拍摄床边侧位X线片。在每个时间点的侧位X线片上测量颈椎后凸角，包括中立位和伸展位。同时测量矫正率及评估日本骨科协会（JOA）脊髓功能评分。手术前后数据采用配对样本t检验或Wilcoxon符号秩检验进行比较。
颅骨牵引和颈椎悬吊牵引期间均未发生神经功能恶化。12例患者神经功能正常，其余34例患者随访结束时JOA评分从11.5±2.8提高至15.4±1.8（P<0.05）。牵引前、术前及末次随访时平均后凸Cobb角分别为66.1°±25.2、28.7°±20.1和17.4°±25.7（P<0.05）。颅骨牵引和悬吊牵引的平均矫正率分别为34.2%和60.6%。其中，单纯悬吊牵引患者的矫正率为69.3%。对于悬吊牵引矫正率低于40%的患者，继续采用联合牵引，悬吊牵引和联合牵引后的矫正率分别为30.7%和67.1%。
颈椎悬吊牵引预矫正治疗严重颈椎后凸畸形效果良好，无创伤且操作简便。联合牵引对悬吊牵引后的补充牵引有效。
