针对严重僵硬脊柱侧凸的术前晕轮重力牵引辅助脊柱后路融合手术的有效性和安全性:匹配队列比较研究

IF 2.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL International Journal of Clinical Practice Pub Date : 2024-04-09 DOI:10.1155/2024/6899125
Yangpu Zhang, Bo Han, Jianqiang Wang, Yuzeng Liu, Yiqi Zhang, Yong Hai, Lijin Zhou
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A retrospective matched-cohort study was conducted and a total of 74 patients from January 2018 to December 2021 in our institution were finally enrolled in this study, including 27 patients in the HGT group and 47 patients in the non-HGT group based on whether patients receive HGT or not. Comprehensive assessments including radiographic outcomes, surgical parameters, and clinical complications were collect and analyzed before and after correction surgery. <i>Results</i>. Of the patients included in the HGT group, 21 had thoracic curvature and 6 had thoracolumbar/lumbar curvature, compared with 38 and 9 in the non-HGT group, respectively (<i>P</i> = 0.66). There was no significant difference in the etiologies of scoliosis between two groups (15/7/3/2 vs. 25/16/4/2, <i>P</i> = 0.85). The main curve in HGT and non-HGT groups were corrected from an average of 113.69°–51.25° and 111.94°–63.79° (<i>P</i> &lt; 0.01). 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引用次数: 0

摘要

背景。严重和僵硬的脊柱侧凸给手术矫正带来了巨大挑战,人们不断寻求创新方法,以提高手术效果并确保患者安全。半重力牵引(HGT)仍然是治疗严重脊柱疾病的重要工具,它提供了一种非手术或术前方法来解决脊柱畸形问题。然而,目前尚不清楚 HGT 对严重僵硬脊柱畸形的矫正效果,也不清楚 HGT 对脊柱截骨等级选择的影响。研究方法开展一项回顾性配对队列研究,根据患者是否接受 HGT,最终纳入了我院 2018 年 1 月至 2021 年 12 月的共 74 例患者,其中 HGT 组 27 例,非 HGT 组 47 例。收集并分析矫正手术前后的影像学结果、手术参数和临床并发症等综合评估。结果。在接受 HGT 治疗的患者中,21 人有胸椎弯曲,6 人有胸腰/腰椎弯曲,而未接受 HGT 治疗的患者中分别有 38 人和 9 人有胸腰/腰椎弯曲()。两组脊柱侧弯的病因无明显差异(15/7/3/2 vs. 25/16/4/2,)。HGT组和非HGT组的主要曲线分别从平均113.69°-51.25°和111.94°-63.79°矫正过来()。HGT 组局灶性脊柱后凸的平均矫正率为 45.43%,明显高于非 HGT 组(33.98%)。两组患者术前的矢状纵轴(SVA)()和胸椎后凸(TK)()参数差异无统计学意义。术后,与非 HGT 组相比,HGT 组的 SVA()和 TK()值明显较低。然而,两组患者在冠状垂直轴(CVA)和椎体顶端平移(AVT)成像参数上没有明显差异()。在 HGT 治疗前的术前手术规划阶段,26 例患者最初被认为适合三柱截骨术(3CO),1 例患者被评估为适合后柱截骨术(PCO)。HGT 治疗后,评估结果发生了变化,11 名患者被确定为 3CO 候选者,16 名患者被认为适合 PCO。非 HGT 组的 3CO 应用比例明显高于 HGT 组()。非 HGT 组的平均失血量(666.67 ± 486.55 毫升 vs. 1024.47 ± 718.46 毫升)明显高于 HGT 组,但两组的手术时间没有差异(297.33 ± 66.89 分钟 vs. 299.15 ± 56.73 分钟)。HGT 组的并发症发生率为 7.4%,明显低于非 HGT 组()。结论。该研究表明,HGT 作为一种可行且安全的策略,在治疗严重僵硬脊柱侧凸方面具有卓越的疗效和安全性,并能在一定程度上减少手术中使用的截骨水平。
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Effectiveness and Safety of Preoperative Halo Gravity Traction-Assisted Posterior Spinal Fusion Surgery for Severe and Rigid Scoliosis: A Comparative Matched-Cohort Study

Background. Severe and rigid scoliosis poses significant challenges in surgical correction, and innovative approaches are continually sought to enhance effectiveness and ensure patient safety. Halo-gravity traction (HGT) continues to be a vital tool in managing severe spinal conditions, offering a nonsurgical or preoperative approach to address spinal deformities. However, the correction effect that HGT can achieve for severe and rigid spinal deformity is currently unclear and the impact of HGT on the selection of spinal osteotomy grade was still unknown. Methods. A retrospective matched-cohort study was conducted and a total of 74 patients from January 2018 to December 2021 in our institution were finally enrolled in this study, including 27 patients in the HGT group and 47 patients in the non-HGT group based on whether patients receive HGT or not. Comprehensive assessments including radiographic outcomes, surgical parameters, and clinical complications were collect and analyzed before and after correction surgery. Results. Of the patients included in the HGT group, 21 had thoracic curvature and 6 had thoracolumbar/lumbar curvature, compared with 38 and 9 in the non-HGT group, respectively (P = 0.66). There was no significant difference in the etiologies of scoliosis between two groups (15/7/3/2 vs. 25/16/4/2, P = 0.85). The main curve in HGT and non-HGT groups were corrected from an average of 113.69°–51.25° and 111.94°–63.79° (P < 0.01). For the HGT group, the mean correction rate of focal kyphosis (FK) was 45.43%, which was significantly higher than those in the non-HGT group (33.98%, P < 0.05). There were no statistically significant differences in preoperative parameters of sagittal vertical axis (SVA) (P = 0.13) or thoracic kyphosis (TK) (P = 0.07) between the two groups. Postoperatively, the HGT group showed significantly lower values in SVA (P = 0.001) and TK (P = 0.001) compared to the non-HGT group. However, there was no significant difference in the imaging parameters coronal vertical axis (CVA) and apical vertebral translation (AVT) between the two groups (P > 0.05). In the preoperative surgical planning phase before HGT treatment, 26 patients were initially considered candidates for 3-column osteotomy (3CO), while one patient was evaluated as suitable for posterior column osteotomy (PCO). Following HGT treatment, the assessment changed with 11 patients identified as candidates for 3CO and 16 patients deemed suitable for PCO. The application proportion of 3CO was significantly higher in the non-HGT group than in the HGT group (P < 0.05). The mean blood loss of the non-HGT group was significantly greater than that of the HGT group (666.67 ± 486.55 ml vs. 1024.47 ± 718.46 ml, P < 0.05), but the surgical time showed no difference between the two groups (297.33 ± 66.89 mins vs. 299.15 ± 56.73 mins, P = 0.90). The incidence of complications in the HGT group was 7.4%, which was significantly lower than that of the non-HGT group (P < 0.05). Conclusion. This study showed that the use of HGT, as a feasible and safe strategy, has superior efficacy and safety for treating severe and rigid scoliosis and can reduce the level of osteotomy used during surgery to some extent.

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期刊介绍: IJCP is a general medical journal. IJCP gives special priority to work that has international appeal. IJCP publishes: Editorials. IJCP Editorials are commissioned. [Peer reviewed at the editor''s discretion] Perspectives. Most IJCP Perspectives are commissioned. Example. [Peer reviewed at the editor''s discretion] Study design and interpretation. Example. [Always peer reviewed] Original data from clinical investigations. In particular: Primary research papers from RCTs, observational studies, epidemiological studies; pre-specified sub-analyses; pooled analyses. [Always peer reviewed] Meta-analyses. [Always peer reviewed] Systematic reviews. From October 2009, special priority will be given to systematic reviews. [Always peer reviewed] Non-systematic/narrative reviews. From October 2009, reviews that are not systematic will be considered only if they include a discrete Methods section that must explicitly describe the authors'' approach. Special priority will, however, be given to systematic reviews. [Always peer reviewed] ''How to…'' papers. Example. [Always peer reviewed] Consensus statements. [Always peer reviewed] Short reports. [Always peer reviewed] Letters. [Peer reviewed at the editor''s discretion] International scope IJCP publishes work from investigators globally. Around 30% of IJCP articles list an author from the UK. Around 30% of IJCP articles list an author from the USA or Canada. Around 45% of IJCP articles list an author from a European country that is not the UK. Around 15% of articles published in IJCP list an author from a country in the Asia-Pacific region.
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