1Department of Orthopedic Surgery, Division of Spine Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
2Department of Orthopedic Surgery, Division of Spine Surgery, Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, China.
J Neurosurg Spine. 2023 Sep 22;39(6):734-741. doi: 10.3171/2023.7.SPINE23290. Print 2023 Dec 1.
The aim of this study was to investigate the effectiveness of preoperative halo-gravity traction (HGT) with subsequent growing rod (GR) treatment in patients with severe early-onset scoliosis (EOS).
The authors retrospectively reviewed a cohort of patients with severe EOS who had received preoperative HGT with subsequent GR treatment at their center between January 2008 and January 2020. Patients with a Cobb angle in the coronal or sagittal plane that was > 90° were included. All patients received at least 6 weeks of HGT before GR placement. Results of pulmonary function tests (PFTs) and blood gas tests were compared before and after HGT. Radiological parameters were compared pre-HGT, post-HGT, postindex surgery, and at the latest follow-up.
A total of 28 patients (17 boys and 11 girls, mean age 6.1 ± 2.3 years) were included in this study. After a mean of 65.2 ± 22.9 days of traction, the Cobb angle decreased from 101.4° ± 12.5° to 74.5° ± 19.3° (change rate 26.5%), and the kyphosis angle decreased from 71.1° ± 21.2° to 42.7° ± 9.5° (change rate 39.9%). There was a significant improvement in BMI but a decrease in hemoglobin levels following HGT. No HGT-related complications were recorded except pin site infections in 2 patients. Statistically significant improvements in PFTs after HGT were observed in forced vital capacity (FVC) (p = 0.011), the percentage predicted FVC (p = 0.007), FEV1 (p = 0.015), and the percentage predicted forced expiratory volume in 1 second (FEV1) (p = 0.005). Fourteen patients received assisted ventilation due to preoperative hypoxia, alveolar hypoventilation, or hypercapnia. Significant improvement was seen in PaCO2 (p = 0.008), PaO2 (p = 0.005), actual bicarbonate (p = 0.005), and oxygen saturation (p = 0.012) in these patients. After the index surgery, the Cobb angle decreased to 49.5° ± 18.9° and the kyphosis angle decreased to 36.2° ± 25.8°. After a mean of 4.3 ± 1.4 lengthening procedures, the Cobb angle was 56.5° ± 15.8°, and the kyphosis angle was 38.8° ± 19.7°. Surgical complications occurred in 14 (50%) patients, but none of these patients required revision surgery at the latest follow-up.
Preoperative HGT notably improved both spinal deformity and pulmonary function in patients with severe EOS. GR treatment after HGT is a safe and effective strategy for these patients.
本研究旨在探讨术前 halo-gravity 牵引（HGT）联合生长棒（GR）治疗在严重早发性脊柱侧凸（EOS）患者中的疗效。
作者回顾性分析了 2008 年 1 月至 2020 年 1 月期间在本中心接受术前 HGT 联合 GR 治疗的严重 EOS 患者队列。纳入的患者冠状面或矢状面 Cobb 角>90°。所有患者在 GR 放置前均接受至少 6 周的 HGT。比较 HGT 前后的肺功能测试（PFT）和血气测试结果。比较 HGT 前、HGT 后、索引手术后和末次随访时的影像学参数。
共纳入 28 例患者（男 17 例，女 11 例，平均年龄 6.1±2.3 岁）。在牵引 65.2±22.9 天后，Cobb 角从 101.4°±12.5°减小至 74.5°±19.3°（变化率 26.5%），后凸角从 71.1°±21.2°减小至 42.7°±9.5°（变化率 39.9%）。HGT 后 BMI 显著改善，但血红蛋白水平下降。除 2 例患者发生针道感染外，未发生 HGT 相关并发症。HGT 后 PFT 中的用力肺活量（FVC）（p=0.011）、预测 FVC 的百分比（p=0.007）、FEV1（p=0.015）和预测 FEV1 的百分比（p=0.005）均有统计学意义的改善。14 例患者因术前缺氧、肺泡通气不足或高碳酸血症需要辅助通气。这些患者的 PaCO2（p=0.008）、PaO2（p=0.005）、实际碳酸氢盐（p=0.005）和氧饱和度（p=0.012）均有显著改善。索引手术后，Cobb 角减小至 49.5°±18.9°，后凸角减小至 36.2°±25.8°。在平均 4.3±1.4 次延长手术后，Cobb 角为 56.5°±15.8°，后凸角为 38.8°±19.7°。14 例（50%）患者发生手术并发症，但在末次随访时，无患者需要再次手术。
术前 HGT 显著改善了严重 EOS 患者的脊柱畸形和肺功能。HGT 后 GR 治疗是这类患者的一种安全有效的治疗策略。
