背景:儿童和青少年的严重脊柱弯曲(SSC)长期接受术前Halo牵引治疗,在各种变化中。还有几种激进的技术可用于管理被忽视的SSC,例如截骨术;然而,这些可能是有风险的。比较术前使用Halo重力牵引(HGT)与使用磁控生长杆(MCGR)作为临时内部牵引(TID)装置时的治疗结果,我们评估了手术和放射学结局的差异.
方法:我们对30例SSCs患者进行了回顾性研究,接受HGT治疗,然后进行后路脊柱融合术(PSF;第1组,n=18)或使用临时MCGR作为TID治疗,然后进行PSF(第2组,n=12)。所有患者在2016年至2022年间接受了手术治疗。纳入标准为SSC>90°,灵活性<30%,以及使用术前HGT,然后进行PSF或进行初始TID棒放置(第1阶段),然后进行PSF(第2阶段)的两阶段外科手术。评估参数如下:肋骨驼峰,树干高度,和射线照相结果。术前收集所有参数,在最初的手术之后,经过最终的校正和融合,在最后的后续行动中。
结果:在第1组中,我们评估了18名平均年龄为15.5岁的患者;在第2组中,我们评估了12名平均年龄为14.2岁的患者。分阶段程序之间的间隔平均为32.7天。第1组和第2组的术前平均主曲线(MC)分别为118°和112°。经过明确的手术,在G1和G2中,MC分别校正为42°和44°。两组MC的平均校正百分比相似(65%vs.G1和G2分别为61%)。术前平均胸椎后凸G1为92.5°,G2为98°,G1为43.8°,G2为38.8°。躯干高度平均增加9厘米。
结论:在青少年被忽视的脊柱侧凸治疗中,使用MCGR作为临时内部牵引装置没有益处。严重脊柱侧凸的手术治疗可能是安全的,降低潜在并发症的风险,术前使用HGT时。当使用MCGR作为临时内部牵引装置时,特定的术中并发症是短暂神经监测变化的50%风险。由于施加在脊柱上的巨大力和脊柱的彻底分散。我们取得了类似的临床成果,射线照相,两种技术的肺功能结果。使用HGT导致更少的失血,麻醉下的总时间更短。通过促进曲率的逐渐减小,部分校正显着有助于后续操作,从而降低手术治疗的难度和神经功能缺损的风险。
BACKGROUND: Severe spinal curvatures (SSCs) in children and adolescents have long been treated with preoperative
Halo traction, in its various variations. There are also several radical techniques available for the management of neglected SSCs, such as osteotomies; however, these can be risky. Comparing the treatment outcomes when using preoperative
Halo Gravity Traction (HGT) against the use of a Magnetically Controlled Growing Rod (MCGR) as a temporary internal distraction (TID) device, we evaluated the differences in surgical and radiological outcomes.
METHODS: We conducted a retrospective study of 30 patients with SSCs, treated with HGT followed by posterior spinal fusion (PSF; Group 1, n = 18) or treated using a temporary MCGR as a TID followed by PSF (Group 2, n = 12). All patients underwent surgical treatment between 2016 and 2022. The inclusion criteria were SSC > 90°, flexibility < 30%, and the use of preoperative HGT followed by PSF or the two-stage surgical procedure with initial TID rod placement (Stage 1) followed by PSF (Stage 2). The evaluated parameters were as follows: rib hump, trunk height, and radiographic outcomes. All parameters were collected preoperatively, after the initial surgery, after final correction and fusion, and during the final follow-up.
RESULTS: In Group 1, we evaluated 18 patients with a mean age of 15.5 years; in Group 2, we evaluated 12 patients with a mean age of 14.2 years. The interval between the staged procedures averaged 32.7 days. The mean preoperative main curves (MC) were 118° and 112° in Group 1 and Group 2, respectively. After definitive surgery, the MC was corrected to 42° and 44° in G1 and G2, respectively. The mean percentage correction of the MC was similar in both groups (65% vs. 61% in G1 and G2, respectively). The mean preoperative thoracic kyphosis was 92.5° in G1 and 98° in G2, corrected to 43.8° in G1 and 38.8° in G2. Trunk height increased by 9 cm on average.
CONCLUSIONS: There are no benefits in using a MCGR as a temporary internal distraction device in the management of neglected scoliosis in adolescents. Surgical treatment of severe scoliosis may be safe, with a reduced risk of potential complications, when using preoperative HGT. A specific intraoperative complication when using a MCGR as a temporary internal distraction device was a 50% risk of transient neuromonitoring changes, due to significant force applied to the spine and radical distraction of the spine. We achieved similar clinical, radiographic, and pulmonary function outcomes for both techniques. The use of HGT causes less blood loss with a shorter overall time under anesthesia. Partial correction significantly aids the subsequent operation by facilitating a gradual reduction in the curvature, thereby reducing the difficulty of surgical treatment and the risk of neurological deficits.