Zhou Lijin, Yang Yihan, Yang Honghao, Wang Jianqiang, Li Zhangfu, Sun Duan, 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.
J Orthop Surg Res. 2025 Jul 26;20(1):705. doi: 10.1186/s13018-025-06126-y.
Severe and rigid kyphoscoliosis, characterized by extreme spinal curvature > 100° and limited flexibility < 30%, significantly impacts pulmonary function. While halo-pelvic traction (HPT) is an established method for improving lung function in patients with scoliosis, the optimal duration of treatment remains undefined.
This study included 64 patients who underwent HPT before posterior spinal fusion surgery. Patients were divided into short-term traction group (2 months < traction duration ≤ 4 months), the middle-term traction group (4 months < traction duration ≤ 6 months), and the long-term traction group (traction duration > 6 months). Pulmonary function tests (PFTs) were performed in all patients. Using three-dimensional (3D) lung reconstruction from computed tomography, changes in lung volume were analyzed. The statistical analyses were conducted using SPSS (version 26.0; IBM) and GraphPad Prism (version 10.1.2).
Among 64 patients, total lung capacity (TLC) increased significantly in the middle‑term traction (2.62 ± 0.89 L to 3.10 ± 0.85 L) and long‑term traction (2.39 ± 0.98 L to 2.98 ± 0.80 L) groups. Total lung volume (TLV) improved significantly in the short‑term (1.81 ± 0.50 L to 2.13 ± 0.44 L), middle‑term (2.62 ± 0.89 L to 3.10 ± 0.85 L), and long‑term (2.39 ± 0.98 L to 2.98 ± 0.80 L) traction groups. Concave-side lung volume also increased significantly in three groups. Middle-term HPT exhibited greater TLV and concave-side lung volume change rate improvement than the short-term group, while long-term HPT showed no additional advantage over middle-term treatment. HPT also significantly improved T1-T12 distance, thoracic kyphosis, and main Cobb angle.
HPT is an effective treatment for severe and rigid kyphoscoliosis, and 4 to 6 months may be the optimal HPT duration to improve pulmonary function.
严重僵硬型脊柱后凸畸形，其特征为脊柱极度弯曲>100°且柔韧性受限<30%，会对肺功能产生重大影响。虽然头盆环牵引（HPT）是改善脊柱侧弯患者肺功能的既定方法，但最佳治疗持续时间仍不明确。
本研究纳入了64例在脊柱后路融合手术前行HPT的患者。患者被分为短期牵引组（牵引持续时间2个月<牵引持续时间≤4个月）、中期牵引组（牵引持续时间4个月<牵引持续时间≤6个月）和长期牵引组（牵引持续时间>6个月）。对所有患者进行肺功能测试（PFTs）。利用计算机断层扫描进行三维（3D）肺重建，分析肺容积变化。使用SPSS（26.0版；IBM）和GraphPad Prism（10.1.2版）进行统计分析。
在64例患者中，中期牵引组（从2.62±0.89L增至3.10±0.85L）和长期牵引组（从2.39±0.98L增至2.98±0.80L）的肺总量（TLC）显著增加。短期（从1.81±0.50L增至2.13±0.44L）、中期（从2.62±0.89L增至3.10±0.85L）和长期（从2.39±0.98L增至2.98±0.80L）牵引组的肺总体积（TLV）均显著改善。三组凹侧肺容积也显著增加。中期HPT在TLV和凹侧肺容积变化率改善方面比短期组更大，而长期HPT与中期治疗相比未显示出额外优势。HPT还显著改善了T1 - T12距离、胸椎后凸和主要Cobb角。
HPT是治疗严重僵硬型脊柱后凸畸形的有效方法，4至6个月可能是改善肺功能的最佳HPT持续时间。
