Coughlin Grace H, Shah Suken A, Gupta Apeksha, Bauer Jennifer M
University of Washington School of Medicine, Seattle, WA, USA.
Biostatistics, Epidemiology and Analytics in Research (BEAR) Core, Seattle Children's Hopsital, Seattle, WA, USA.
Eur Spine J. 2025 Feb;34(2):602-609. doi: 10.1007/s00586-024-08598-8. Epub 2024 Dec 10.
Intraoperative traction can improve deformity correction during posterior spinal fusion (PSF). This is commonly done with invasive distal femoral or pelvic pins, or traction boots. The novel technique of intraoperative skin traction (ISkinT) avoids risks associated with intraoperative skeletal traction (ISkelT) or hyperlordosis with extended hip position. We aimed to describe ISkinT and assess its safety and efficacy in PSF in non-ambulatory scoliosis.
Retrospective review of patients aged 10-21yo who underwent T2-pelvis PSF with ISkinT from 2017 to 2023. Demographics and radiographic measurements were statistically compared to a published cohort that used ISkelT.
42 patients treated with ISkinT were included and compared to 41 patients treated with ISkelT. ISkinT was applied by a cranial attachment and an average of 12% body weight to the pelvis with the hips and knees flexed, using tape-rope-weight system with Trendelenburg assistance. The preop major Cobb was 90°±21° in the ISkinT cohort and 91°±17° in the ISkelT cohort (p = 0.743; d = 0.07), which corrected 75% in ISkinT and 53% in ISkelT (p < 0.0001; d = 1.3). Preop pelvic obliquity averaged 23°± 10° in ISkinT and 34°±14° in ISkelT that corrected 74% in ISkinT and 65% in ISkelT (p < 0.0001; d = 0.95). No intraop or postoperative skin traction-related complications occurred, including neuromonitoring complications (obtained in 88%).
In non-ambulatory neuromuscular pediatric scoliosis patients, ISkinT during PSF to the pelvis is a safe and effective technique for deformity correction. There were no associated complications and no difference of corrective capacity for ISkinT compared to ISkelT. ISkinT can be considered for T2-pelvis PSF for pediatric scoliosis.
术中牵引可改善后路脊柱融合术（PSF）期间的畸形矫正。这通常通过侵入性的股骨远端或骨盆钢针，或牵引靴来完成。术中皮肤牵引（ISkinT）的新技术避免了与术中骨骼牵引（ISkelT）或髋关节伸展位导致的腰椎前凸增加相关的风险。我们旨在描述ISkinT，并评估其在非行走性脊柱侧凸PSF中的安全性和有效性。
回顾性分析2017年至2023年接受T2-骨盆PSF并采用ISkinT的10-21岁患者。将人口统计学和影像学测量结果与使用ISkelT的已发表队列进行统计学比较。
纳入42例接受ISkinT治疗的患者，并与41例接受ISkelT治疗的患者进行比较。ISkinT通过颅骨固定装置施加，在髋关节和膝关节屈曲的情况下，使用带绳重物系统并在Trendelenburg体位辅助下，平均向骨盆施加12%体重的牵引力。ISkinT队列术前主 Cobb角为90°±21°，ISkelT队列术前主 Cobb角为91°±17°（p = 0.743；d = 0.07），ISkinT矫正率为75%，ISkelT矫正率为53%（p < 0.0001；d = 1.3）。ISkinT术前骨盆倾斜平均为23°±10°，ISkelT术前骨盆倾斜平均为34°±14°，ISkinT矫正率为74%，ISkelT矫正率为65%（p < 0.0001；d = 0.95）。未发生术中或术后与皮肤牵引相关的并发症，包括神经监测并发症（88%进行了神经监测）。
在非行走性神经肌肉型小儿脊柱侧凸患者中，PSF期间对骨盆进行ISkinT是一种安全有效的畸形矫正技术。与ISkelT相比，ISkinT没有相关并发症，且矫正能力无差异。对于小儿脊柱侧凸的T2-骨盆PSF，可考虑采用ISkinT。
