大重量Halo-股骨髁上牵引在重度僵硬性非特发性脊柱侧凸矫形中贡献率的分析

发布时间：2018-03-21 20:44

本文选题：Halo-股骨髁上牵引　切入点：后路矫形　出处：《中国矫形外科杂志》2017年19期 　论文类型：期刊论文

【摘要】：[目的]分析大重量Halo-股骨髁上牵引在治疗重度僵硬性非特发性脊柱侧凸中的矫形贡献率及临床意义。[方法]对2008年12月~2011年8月在本科住院并采用湘雅阶梯渐进式大重量Halo-股骨髁上牵引的26例重度僵硬性非特发性脊柱侧凸患者进行回顾性分析。所有病例术前均行Halo-双侧股骨髁上牵引,牵引2~4周后,术中维持牵引下行一期后路松解内固定矫形植骨融合术。通过测量术前全长站立正位、仰卧位Bending像,支点加压位、牵引后、术后侧凸Cobb角,对各矫形要素(Bending、支点加压、牵引、手术)绝对和相对贡献率进行统计学分析。[结果]牵引过程中未出现钉道松动、感染等并发症,术中及术后均无瘫痪、呼吸衰竭及死亡等并发症,随访时间为(42~70)个月,平均为54.00个月;随访期间无断钉、断棒等现象发生。术前站立位主弯侧凸Cobb角平均93.00°±18.90°(71.00°~121.00°),仰卧位Bending像平均为74.70°±20.04°(52.50°~106.00°),支点加压位平均为68.90°±18.21°(48.00°~96.60°),牵引后平均为59.80°±15.82°(42.00°~79.80°),术后平均为40.60°±12.09°(23.00°~58.10°);各矫形要素(Bending、支点加压、牵引、手术)的绝对贡献率为20.50%±6.02%、6.22%±3.29%、9.63%±5.42%、20.58%±8.61%,总贡献率为56.83%±6.87%(51.50%~67.61%)。2例患者牵引过程中出现背部后凸处皮肤压红,5例出现不同程度膝、髋关节僵硬。[结论]在重度僵硬性非特发性脊柱侧凸治疗中,采用湘雅阶梯渐进式大重量Halo-股骨髁上牵引,矫形贡献率相对突出,可有效地使矫形风险分散,降低手术风险,是治疗重度僵硬型非特发性脊柱侧凸一种安全、有效的方法。
[Abstract]:[objective] to analyze the orthopedic contribution rate and clinical significance of high-weight Halo-femoral supracondylar traction in the treatment of severe stiff non-idiopathic scoliosis. A retrospective analysis was performed on 26 patients with severe rigid nonidiopathic scoliosis who underwent high weight Halo-femoral supracondylar traction. All patients were treated with Halo-bilateral supracondylar traction before operation. After 2 weeks of traction, the orthopedic bone graft fusion was performed with one stage posterior release and internal fixation during the operation. Bending images of standing position, supine position, fulcrum compression position, Cobb angle of postoperative scoliosis were measured before and after traction. The absolute and relative contribution rates of various orthopaedic elements, such as Bending, fulcrum compression, traction, surgery) were analyzed statistically. [results] there were no complications such as loosening of the nail canal and infection during traction, and no paralysis occurred during or after operation. Complications such as respiratory failure and death were followed up for 42 ~ 70 months with an average of 54.00 months. The mean Cobb angle of the standing position was 93.00 掳卤18.90 掳/ 71.00 掳/ 121.00 掳/ m, the mean value of the supine position was 74.70 掳卤20.04 掳/ 52.50 掳/ 106.00 掳/ m, the average value of the fulcrum pressure position was 68.90 掳卤18.21 掳48.00 掳/ 96.60 掳/ m, the average value was 59.80 掳卤15.82 掳/ 42.00 掳/ 79.80 掳and 40.60 掳卤12.09 掳/ 23.00 掳/ 58.10 掳respectively. The absolute contribution rate was 20.50% 卤6.02% 卤3.29% 卤9.63% 卤5.42% 卤8.61%, and the total contribution rate was 56.83% 卤6.87% 卤6.87% 卤67.61%. During traction, 5 cases with kyphosis and 5 cases with hip stiffness. [conclusion] in the treatment of severe stiff non-idiopathic scoliosis, the total contribution rate is 56.83% 卤6.87% 卤67.61%. [conclusion] in the treatment of severe stiff non-idiopathic scoliosis, the total contribution rate is 56.83% 卤6.87% 卤67.61%. Using Xiangya step by step large weight Halo-femur supracondylar traction, the orthopedic contribution rate is relatively prominent, which can effectively spread the orthopedic risk and reduce the surgical risk. It is a safe and effective method for the treatment of severe stiff non-idiopathic scoliosis.
【作者单位】：中南大学湘雅医院脊柱外科湘雅脊柱外科中心;
【基金】：国家自然科学基金项目(编号:81472145) 湖南省“芙蓉学者”项目
【分类号】：R687.3

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