Ilyas Muhammad Saad, Shah Abdullah, Zehra Uruj, Ismail Muhammad, Elahi Haseeb, Aziz Amer
Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan.
Department of Anatomy, University of Health Sciences, Lahore, Pakistan.
Asian Spine J. 2024 Aug;18(4):522-531. doi: 10.31616/asj.2024.0104. Epub 2024 Aug 9.
A 2-year follow-up study.
To evaluate the effectiveness of modified halo-pelvic Ilizarov distraction assembly in the management of patients with severe kyphoscoliosis.
Severe and rigid scoliosis curves are always a challenge for operating surgeons. Preoperative correction through halo-pelvic devices successfully minimizes the severity of the curve; however, cumbersome complications are also reported with its use. Modified assembly could be safe for these cases.
Patients with severe kyphoscoliosis having coronal Cobb angle >90° were applied with modified halo-pelvic Ilizarov distraction assembly preoperatively. The modified assembly consisted of a pelvic component and halo ring, and distraction was given at the rate of 2-3 mm/day for 6-12 weeks. Complete clinical assessments along with pulmonary function tests were performed, and scoliosis series X-ray images were assessed for coronal and sagittal Cobb angle and other spinopelvic parameters before applying the assembly and during 2 years of follow-up.
Thirty-four patients (age, 9-27 years; male/female ratio of 18:16) were included. The coronal and sagittal Cobb angles were 116°±16.2° and 84°±28.3°, respectively. Correction rates obtained through modified halo-pelvic assembly were nearly 52% (p=0.001) in coronal and 40% (p=0.001) in sagittal Cobb angles, with improvement in height (p=0.001). Apical vertebral translation and coronal balance were also improved significantly (p=0.001). Further improvements in all the parameters were obtained after definitive surgery, with improvements in the forced expiratory volume in 1 second (p =0.002) and forced vital capacity (p=0.001).
Our modified halo-pelvic Ilizarov distraction assembly can achieve good correction in severe spinal deformities without significant risk to neurology, has fewer complications, and promotes good patient compliance.
一项为期2年的随访研究。
评估改良式头盆环Ilizarov撑开装置在重度脊柱侧凸患者治疗中的有效性。
严重且僵硬的脊柱侧凸曲线一直是手术医生面临的挑战。通过头盆环装置进行术前矫正成功地将曲线的严重程度降至最低；然而，使用该装置也会出现一些麻烦的并发症。改良式装置对这些病例可能是安全的。
对冠状面Cobb角>90°的重度脊柱侧凸患者术前应用改良式头盆环Ilizarov撑开装置。改良式装置由骨盆部件和头环组成，以每天2 - 3毫米的速度撑开6 - 12周。在应用该装置前以及随访的2年期间，进行了全面的临床评估以及肺功能测试，并对脊柱侧凸系列X线图像进行评估，以测量冠状面和矢状面的Cobb角以及其他脊柱骨盆参数。
纳入34例患者（年龄9 - 27岁；男女比例为18:16）。冠状面和矢状面的Cobb角分别为116°±16.2°和84°±28.3°。通过改良式头盆环装置获得的矫正率在冠状面Cobb角接近52%（p = 0.001），在矢状面Cobb角为40%（p = 0.001），身高有所增加（p = 0.001）。顶椎平移和冠状面平衡也有显著改善（p = 0.001）。在确定性手术后，所有参数进一步改善，第1秒用力呼气量（p = 0.002）和用力肺活量（p = 0.001）也有所改善。
我们的改良式头盆环Ilizarov撑开装置能够在严重脊柱畸形中实现良好的矫正，对神经学无显著风险，并发症较少，并能提高患者的依从性。
