背景:严重和僵硬的脊柱侧凸代表一种脊柱畸形,其特征是Cobb角超过90°,柔韧性小于30%。Halo脊柱牵引仍然是治疗严重脊柱侧凸的既定标准,尽管存在替代方法,例如临时内部牵引棒和分阶段手术矫正。本研究的主要目的是比较两组使用这些不同方法治疗的患者,以确定手术和放射学结果方面的差异。肺功能(PF),和生活质量(QoL)。方法:本研究共纳入62名符合指定标准的儿科患者,其中包括严重特发性脊柱侧凸(主要Cobb曲线>90)和柔韧性<30%。第1组(G1)进行了手术干预,包括术前Halo重力牵引(HGT),后路脊柱融合术(PSF)成功。另一方面,第2组(G2)在PSF之前进行了两阶段的手术,首先是侵入性较小的临时内部牵引技术(LITID)。放射学结果,PF,在2至5年的监测期内记录和评估QoL。结果:术前平均主要曲线(MC)分别在G1和G2中测量为124°和122°(p<0.426)。初始灵活性,如在术前弯曲膜中观察到的,从G1的18%到G2的21%(p<0.001)。在最终的手术干预之后,在G1和G2中,MC分别校正为45°和37.4°(p<0.001)。G2中MC的校正百分比较高(63%vs.G1和G2分别为70%),组间差异显著(p<0.001)。术前平均胸椎后凸(TKs)G1为96.5°,G2为92°(p=0.782),G1校正为45.8°,G2校正为36.2°(p<0.001),相当于各组中55%和60%的矫正率。最初,与G1相比,G2的预测肺容积(FVC)和预测FEV1的百分比值较低(49%和58%vs.54.5%和60.8%;不适用)。尽管如此,在随访期间,两组患者的FVC和FEV1值都有改善.结论:在儿童和青少年人群中,严重和未经治疗的脊柱弯曲的手术治疗可以被认为是安全的,轻微并发症的发生率是可以容忍的。LITID是一种提供改善的QoL和肺功能的方法,在冠状平面和矢状平面中实现明显的平均畸形矫正70%和60%,同时平均增加10.8厘米的树干高度。此外,典型的肋骨驼峰减少76%,呼吸功能增强,如1s预测用力呼气量(25-56%)和用力肺活量(35-65%)的改善所示,实现了,当使用SRS-22r评估时,导致QoL的临床和统计学显着提高,不诉诸更激进的,高风险程序。
Background: Severe and rigid scoliosis represents a type of spinal deformity characterized by a Cobb angle exceeding 90° and a flexibility of less than 30%. Halo spinal traction remains the established standard for managing severe scoliosis, although alternative approaches such as temporary internal distraction rods and staged surgical correction exist. The primary objective of this investigation was to compare two cohorts of patients treated using these distinct methods to ascertain any divergences in terms of surgical and radiological outcomes, pulmonary function (PF), and quality of life (QoL). Methods: This study encompassed a total of 62 pediatric patients meeting the specified criteria, which included severe idiopathic scoliosis (major Cobb curve >90) and flexibility <30%. Group 1 (G1) underwent surgical intervention involving preoperative Halo gravity traction (
HGT) succeeded by posterior spinal fusion (PSF). On the other hand, Group 2 (G2) underwent a two-stage procedure starting with a less invasive temporary internal distraction technique (LITID) prior to PSF. The radiological outcomes, PF, and QoL were documented and assessed over a monitoring period ranging from 2 to 5 years. Results: The average preoperative major curves (MCs) measured 124° and 122° in G1 and G2, respectively (p < 0.426). Initial flexibility, as observed in preoperative bending films, ranged from 18% in G1 to 21% in G2 (p < 0.001). Following the ultimate surgical intervention, the MCs were corrected to 45° and 37.4° in G1 and G2, respectively (p < 0.001). The percentage correction of the MCs was higher in G2 (63% vs. 70% in G1 and G2, respectively), with significant between-group disparities (p < 0.001). The mean preoperative thoracic kyphoses (TKs) were 96.5° in G1 and 92° in G2 (p = 0.782), which were rectified to 45.8° in G1 and 36.2° in G2 (p < 0.001), equating to correction rates of 55% and 60% in the respective groups. Initially, G2 exhibited lower values for the percentage of predicted lung volume (FVC) and predicted FEV1 compared with G1 (49% and 58% vs. 54.5% and 60.8%; N.S.). Nonetheless, both groups demonstrated enhancements in their FVC and FEV1 values over the follow-up period. Conclusions: The surgical management of severe and untreated spinal curvatures in the pediatric and adolescent population can be considered safe, with a tolerable incidence of minor complications. LITID emerges as a method offering improved QoL and pulmonary function, achieving notably substantial average corrections in deformity by 70% in the coronal plane and 60% in the sagittal plane, alongside a mean increase in trunk height of 10.8 cm. Furthermore, a typical reduction of 76% in rib humps and enhancements in respiratory function, as indicated by improvements in 1 s predicted forced expiratory volume (by 25-56%) and forced vital capacity (by 35-65%), were achieved, leading to a clinically and statistically significant enhancement in QoL when evaluated using SRS-22r, without resorting to more radical, high-risk procedures.