Zhou Lijin, Wang Jianqiang, Yang Honghao, Zhang Yiqi, Wang Yunsheng, Hai Yong
Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, Beijing, China.
Clinical Center for Spinal Deformity, Capital Medical University of China, Beijing, China.
Global Spine J. 2025 Jun 1:21925682251348670. doi: 10.1177/21925682251348670.
Study DesignMatched Retrospective Cohort Study.ObjectiveTo compare efficacy and safety of Halo gravity traction vs Halo pelvic traction in severe rigid spinal deformity.MethodsWe retrospectively reviewed 104 severe rigid spinal deformity patients treated with preoperative Halo traction and posterior correction surgery (2016.1-2022.12). Patients were matched 1:1 by main curve Cobb angle and age into HGT and HPT groups (33 each). Radiographic parameters were assessed before and after traction, preoperatively, and at final follow-up. Surgical planning for osteotomy and fusion segments used pre-traction imaging, compared with actual outcomes. Traction duration, surgical parameters, and complications were recorded.ResultsHGT patients had 4.5 ± 1.5 months traction, improving main curve from 138.4° to 94.9° (23.5%) and kyphosis from 87.9° to 73.1° (22.6%), with postoperative values of 51.1° and 39.7°. HPT patients had 5.1 ± 1.1 months of traction, improving main curve from 143.2° to 69.6° (51.3%) and kyphosis from 117.7° to 56.8° (49.1%), with postoperative values of 56.1° and 34.5°. HPT showed better improvement ( < 0.05). HPT achieved 50% deformity improvement after 3 months, vs 5 months for HGT. By 7 months, >60% of HPT vs <10% of HGT patients reached this threshold. Planned three-column osteotomy dropped from 90.9% to 51.5% (actual 36.4%) in HGT and 84.8% to 21.2% (actual 9.1%) in HPT. HPT reduced osteotomy grade ( < 0.05) and fusion segments ( = 0.02) more effectively. Complication rates were similar.ConclusionsBoth HGT and HPT improve preoperative deformity, but HPT is more effective and better in reducing osteotomy grades and fusion segments.
研究设计
配对回顾性队列研究。
目的
比较头环重力牵引与头环骨盆牵引治疗严重僵硬性脊柱畸形的疗效和安全性。
方法
我们回顾性分析了104例接受术前头环牵引及后路矫正手术的严重僵硬性脊柱畸形患者（2016年1月至2022年12月）。根据主弯Cobb角和年龄将患者1:1配对分为头环重力牵引组（HGT）和头环骨盆牵引组（HPT），每组33例。在牵引前后、术前及末次随访时评估影像学参数。将截骨和融合节段的手术规划与实际结果进行对比，以牵引前影像学检查为准。记录牵引时间、手术参数及并发症。
结果
HGT组患者牵引时间为4.5±1.5个月，主弯从138.4°改善至94.9°（改善率23.5%），后凸从87.9°改善至73.1°（改善率22.6%），术后主弯为51.1°，后凸为39.7°。HPT组患者牵引时间为 5.1±1.1个月，主弯从143.2°改善至69.6°（改善率51.3%），后凸从117.7°改善至56.8°（改善率49.1%），术后主弯为56.1°，后凸为34.5°。HPT组改善效果更佳（P<0.05）。HPT组在3个月后畸形改善率达到50%，而HGT组为5个月。到7个月时，HPT组超过60%的患者达到该阈值，而HGT组不到10%。HGT组计划的三柱截骨从90.9%降至51.5%（实际为36.4%），HPT组从84.8%降至21.2%（实际为9.1%）。HPT组更有效地降低了截骨分级（P<0.05）和融合节段数量（P = 0.02）。并发症发生率相似。
结论
HGT和HPT均能改善术前畸形，但HPT在降低截骨分级和融合节段数量方面更有效且效果更好。
