术前Halo重力牵引对重度僵硬型脊柱侧凸患者肺功能和营养状况的作用

摘要

目的 探究术前Halo重力牵引在改善重度僵硬型脊柱侧凸患者脊柱畸形、肺功能以及营养状况方面的应用价值.方法 回顾性分析2012年11月—2015年12月在本院行术前Halo重力牵引的重度僵硬型脊柱侧凸的15例患者资料,其中男5例,女10例;年龄13~37岁,平均21.3岁.采用全脊柱影像学检查中主弯Cobb角度评价脊柱畸形程度,用力肺活量(FVC)与预测值的百分比(FVC%)评价肺功能,体质量指数(BMI)和血浆白蛋白浓度衡量患者的一般营养状况.对牵引前后上述指标进行比较分析.结果 经平均135.6 d的Halo重力牵引后,患者主弯Cobb角由牵引前92.1°±26.2°改善至牵引后74.8°±3.2°,矫形效果达(20±16)%.FVC%由(60.0±15.0)%上升至(67.0±9.6)%.BMI值由牵引前(16.4±3.9)kg/m2小幅升高至(18.0±2.8)kg/m2,血浆白蛋白浓度由牵引前(42.3±3.4)g/L小幅升高至(45.4±2.3)g/L.牵引前后患者主弯Cobb角、FVC%、BMI值及血浆白蛋白浓度比较,差异均具有统计学意义(P<0.05).结论 术前Halo重力牵引对于重度僵硬型脊柱侧凸患者有一定的改善肺功能、矫正脊柱畸形的作用,但在提高患者营养状况方面的作用有限.%Objective To investigate the efficacy of preoperative Halo gravity traction for the improvement of pulmonary function and nutritional status and correction of spinal deformity in patients with severe rigid scoliosis. Methods The data of 15 patients with severe rigid scoliosis treated by Halo-gravity traction from November 2012 to December 2015 were retrospectively analyzed,including 5 males and 10 females,aged 13 to 37 years,mean 21.3 years. The forced vital capacity (FVC) and percentage of predicted value(FVC%) were used to evaluate pulmonary function. The degree of spinal deformity was evaluated by the Cobb's angle of major curve on the whole spine roentgenograph. The body mass index(BMI) and plasma albumin concentration of patients were determined pre-and post-traction to evaluate the nutritional status. The differences were analyzed and compared. Results The duration of Halo-gravity traction was 135.6 d. The Cobb's angel was reduced to 74.8°±3.2° from 92.1°±26.2°;the improvement rate was (20±16)%. And FVC%raised significantly from (60.0±15.0)% to (67.0±9.6)%. The BMI was improved from (16.4±3.9)kg/m2 to (18.0±2.8)kg/m2. The plasma albumin was increased slightly from (42.3±3.4)g/L to (45.4±2.3)g/L. The Cobb's angle of major curve,FVC%,BMI and plasma albumin concentration of the patients were all improved at post-traction,and compared with those of the pre-traction,the difference was statistically significant(P<0.05). Conclusion The improvement of pulmonary function and coronal curves by Halo-gravity traction get proved,but the role is limited in improving the nutritional status of patients.