术前Halo重力牵引辅助治疗青少年重度脊柱侧凸畸形的临床疗效

摘要

目的:探讨术前Halo重力牵引辅助治疗青少年重度脊柱侧凸畸形患者的临床疗效.方法:回顾性分析2009年1月至2014年12月第二军医大学长征医院脊柱外科收治的37例青少年重度脊柱侧凸患者的临床资料,所有患者术前均接受Halo重力牵引治疗,随访时间1～4个月.结果:与牵引前相比,牵引后冠状面Cobb角明显降低,差异有统计学意义[(99.5±14.4)° vs(73.2±9.3)°,P<0.01].与牵引前相比,牵引后患者用力肺活量(forced vital capacity,FVC)明显上升[(1.97±0.35)L vs(2.34±0.22)L],1秒用力呼气容积(forced expiratory volume in one second,FEV1)明显上升[(1.75±0.28)L vs(2.08±0.15)L],血浆白蛋白明显上升[(33±9)g/L vs(38±3)g/L],差异均有统计学意义(P<0.01).牵引前后主弯变化量与FVC变化量正相关(r=0.230,P=0.004),与FEV1变化量正相关(r=0.216,P=0.007).牵引过程中1例患者出现左上肢麻木.结论:术前Halo重力牵引可缓慢矫正重度脊柱侧凸青少年患者脊柱畸形,增强肺功能水平,提高营养水平,但应避免牵引相关神经并发症的发生.%Objective:To investigate the clinical efficacy of preoperative Halo gravity traction in the treatment of severe adolescent scoliosis.Methods:The clinical data of 37 cases of severe scoliosis in adolescents admitted to Department of Spine Surgery,Changzheng Hospital from January 2009 to December 2014 were retrospectively analyzed.All patients received Halo gravity traction before operation,and the follow-up time ranged from 1 to 4 months.Objective:Compared with before traction,forced vital capacity(FVC)increased significantly([1.97±0.35] L vs [2.34±0.22] L),forced expiratory volume in one second(FEV1)increased significantly([1.75±0.28] L vs [2.08±0.15] L),plasma albumin increased significantly([33±9] g/L vs [38±3] g/L),and the differences were all statistically significant(P<0.01).The change of main curve before and after traction was positively correlated with FVC change(r=0.230,P=0.004)and FEV1 change(r=0.216,P=0.007).During the traction,1 patient experienced transient brachial plexus palsy.Conclusions:Preoperative Halo gravity traction can gradually correct the spinal deformity,enhance the pulmonary function,and improve the nutrition level of adolescent patients with severe scoliosis.But traction-related neurological complications should be prevented.