摘要
目的 探讨一期改良Halo骨盆牵引(halo-pelvic traction,HPT)联合二期手术对重度脊柱畸形伴呼吸功能障碍患者的应用效果.方法 选取 2019 年 1 月至 2022 年 1 月北京大望路急诊抢救医院收治的 120 例重度脊柱畸形伴呼吸功能障碍患者作为研究对象.所有患者均行一期HPT牵引治疗和二期脊柱畸形矫形术.牵引前、牵引末次复查、内固定术后、末次随访,比较患者影像学指标和呼吸功能指标的变化情况.结果 牵引前,患者主弯侧凸Cobb角、颈 7 铅垂线至骶骨正中线的距离(C7PL-CSVL)、顶椎偏距(AVT)、T1 倾斜角、影像学肩高度、矢状面偏移(SVA)、腰胸椎后凸角(TK)为(119.17±15.39)°、(33.33±7.2)mm、(103.55±16.56)mm、(20.13±5.94)°、(26.78±6.32)mm、(38.29±5.54)mm、(87.66±11.63)°,高于牵引末次复查[(74.62±15.15)°、(13.23±4.27)mm、(57.70±17.56)mm、(9.29±1.73)°、(10.18±2.00)mm、(14.41±3.24)mm、(52.96±12.11)°]、内固定术后[(60.78±14.40)°、(12.42±3.58)mm、(44.31±13.77)mm、(8.89±2.66)°、(9.38±2.39)mm、(17.11±3.24)mm、(51.28±11.20)°]和末次随访[(64.21±14.86)°、(12.69±3.26)mm、(45.17±11.65)mm、(6.51±1.77)°、(9.53±2.36)mm、(17.50±3.07)mm、(51.82±12.20)°],差异有统计学意义(P<0.01).牵引前,患者 FVC、FVC%、FEV1、FEV1%为(1.13±0.19)L、(31.61±4.64)%、(1.08±0.22)L、(29.68±11.56)%,低于牵引末次复查[(1.36±0.28)L、(36.19±4.95)%、(1.17±0.19)L、(33.45±5.97)%]、内固定术后[(1.49±0.28)L、(38.08±7.46)%、(1.26±0.22)L、(35.91±7.81)%]和末次随访[(1.53±0.26)L、(38.61±6.91)%、(1.28±0.24)L、(36.88±7.85)%],差异有统计学意义(P<0.01).结论 改良HPT牵引能有效矫正重度脊柱畸形伴呼吸功能障碍患脊柱畸形,改善呼吸功能,是一种安全、有效地辅助治疗措施.
Abstract
Objective To explore the clinical effect of one-stage modified Halo-pelvic traction combined with two-stage surgery on severe spinal deformity accompanied by respiratory disorder.Methods From January 2019 to January 2022,a total of 120 patients with severe spinal deformity accompanied by respiratory disorder were enrolled at Beijing Dawang Lu Emergency Hospital.All patients underwent modified Halo-pelvic traction followed by surgical correction.The changes in imaging and respiratory function indicators were compared at pre-traction,post-traction,post-operation and the last follow-up.Results At pre-traction,the Cobb angle at the main curvature,distance between the C7 plumb line and the central sacral vertical line(C7PL-CSVL),apical vertebral translation(AVT),T1 tilt angle,radiographic shoulder height,sagittal vertical axis(SVA),and thoracic kyphosis(TK)were(119.17±15.39)°,(33.33±7.2)mm,(103.55±16.56)mm,(20.13±5.94)°,(26.78±6.32)mm,(38.29±5.54)mm,and(87.66±11.63)°,respectively.They were significantly higher than those at post-traction([74.62±15.15]°,[13.23±4.27]mm,[57.70±17.56]mm,[9.29±1.73]°,[10.18±2.00]mm,[14.41±3.24]mm,and[52.96±12.11]°,respectively),post-operation([60.78±14.40]°,[12.42±3.58]mm,[44.31±13.77]mm,[8.89°±2.66]°,[9.38±2.39]mm,[17.11±3.24]mm,and[51.28±11.20]°,respectively)and last follow-up([64.21±14.86]°,[12.69±3.26]mm,[45.17±11.65]mm,[6.51±1.77]°,[9.53±2.36]mm,[17.50±3.07]mm,and[51.82±12.20]°,respectively)(P<0.01).At pre-traction,the forced vital capacity(FVC),FVC%,forced expiratory volume(FEV1)and FEV1%were(1.13±0.19)L,(31.61±4.64)%,(1.08±0.22)L,and(29.68±11.56)%,respectively.They were significantly lower than those at post-traction([1.36±0.28]L,[36.19±4.95]%,[1.17±0.19]L,and[33.45±5.97]%,respectively),post-operation([1.49±0.28]L,[38.08±7.46]%,[1.26±0.22]L,and[35.91±7.81]%,respectively)and the last follow-up([1.53±0.26]L,[38.61±6.91]%,[1.28±0.24]L,and[36.88±7.85]%)(P<0.01).Conclusion Modified Halo-pelvic traction can effectively correct spinal deformity of patients with severe spinal deformity accompanied by respiratory disorder,and improve the respiratory function,which is a safe and effective adjuvant treatment measure.
维普
万方数据