Effectiveness and safety of preoperative distraction using modified halo-pelvic Ilizarov distraction assembly in patients with severe kyphoscoliosis.

IF 2.3 Q2 ORTHOPEDICS Asian Spine Journal Pub Date : 2024-08-01 Epub Date: 2024-08-09 DOI:10.31616/asj.2024.0104
Muhammad Saad Ilyas, Abdullah Shah, Uruj Zehra, Muhammad Ismail, Haseeb Elahi, Amer Aziz
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Abstract

Study design: A 2-year follow-up study.

Purpose: To evaluate the effectiveness of modified halo-pelvic Ilizarov distraction assembly in the management of patients with severe kyphoscoliosis.

Overview of literature: Severe and rigid scoliosis curves are always a challenge for operating surgeons. Preoperative correction through halo-pelvic devices successfully minimizes the severity of the curve; however, cumbersome complications are also reported with its use. Modified assembly could be safe for these cases.

Methods: Patients with severe kyphoscoliosis having coronal Cobb angle >90° were applied with modified halo-pelvic Ilizarov distraction assembly preoperatively. The modified assembly consisted of a pelvic component and halo ring, and distraction was given at the rate of 2-3 mm/day for 6-12 weeks. Complete clinical assessments along with pulmonary function tests were performed, and scoliosis series X-ray images were assessed for coronal and sagittal Cobb angle and other spinopelvic parameters before applying the assembly and during 2 years of follow-up.

Results: Thirty-four patients (age, 9-27 years; male/female ratio of 18:16) were included. The coronal and sagittal Cobb angles were 116°±16.2° and 84°±28.3°, respectively. Correction rates obtained through modified halo-pelvic assembly were nearly 52% (p=0.001) in coronal and 40% (p=0.001) in sagittal Cobb angles, with improvement in height (p=0.001). Apical vertebral translation and coronal balance were also improved significantly (p=0.001). Further improvements in all the parameters were obtained after definitive surgery, with improvements in the forced expiratory volume in 1 second (p =0.002) and forced vital capacity (p=0.001).

Conclusions: Our modified halo-pelvic Ilizarov distraction assembly can achieve good correction in severe spinal deformities without significant risk to neurology, has fewer complications, and promotes good patient compliance.

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对重度脊柱后凸患者使用改良的 halo-pelvic Ilizarov 牵引组件进行术前牵引的有效性和安全性。
研究设计目的:评估改良晕盆伊利扎罗夫牵引组件在治疗严重脊柱侧凸患者中的有效性:严重而僵硬的脊柱侧弯一直是外科医生面临的挑战。通过光环骨盆装置进行术前矫正可成功地将脊柱侧弯的严重程度降至最低,但也有报道称使用该装置会产生繁琐的并发症。对这些病例而言,改良装配可能是安全的:方法:对冠状面 Cobb 角大于 90° 的严重脊柱后凸患者,在术前使用改良的半身-骨盆 Ilizarov 牵张装置。改良组件由骨盆组件和光环组成,以每天 2-3 毫米的速度牵引 6-12 周。在使用该组件之前和两年的随访期间,对患者进行了全面的临床评估和肺功能测试,并对脊柱侧凸系列 X 光图像进行了冠状面和矢状面 Cobb 角以及其他脊柱骨盆参数的评估:共纳入 34 名患者(年龄为 9-27 岁,男女比例为 18:16)。冠状角和矢状角分别为116°±16.2°和84°±28.3°。通过改良光环-骨盆组件获得的矫正率为:冠状角近52%(P=0.001),矢状角40%(P=0.001),高度也有所改善(P=0.001)。椎体顶端平移和冠状面平衡也有明显改善(p=0.001)。最终手术后,所有参数都得到了进一步改善,1秒用力呼气容积(p=0.002)和用力生命容量(p=0.001)也得到了改善:结论:我们的改良晕盆Ilizarov牵引组件可对严重脊柱畸形进行良好矫正,且不会对神经系统造成重大风险,并发症较少,患者依从性良好。
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来源期刊
Asian Spine Journal
Asian Spine Journal ORTHOPEDICS-
CiteScore
5.10
自引率
4.30%
发文量
108
审稿时长
24 weeks
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