牵引结合后路手术治疗重度脊柱侧凸的疗效分析【本科临床医学论文设计下载】.doc

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1、临床医学论文•牵引结合后路手术治疗重度脊柱侧凸的疗效分析作者：张宏其王永福唐明星刘金洋赵迪刘少华陈凌强郭超峰【摘要】〔目的〕探讨Halo-®骨髀上牵引结合后路矫形对柔韧性30%〜40%的重度脊柱侧凸患者的疗效。〔方法〕对2000年1月〜2006年6月治疗的41例柔韧性30%〜40%重度脊柱侧凸患者，按照是否行牵引治疗分为两组。牵引组A组22例，主侧凸平均Cobb's角91.2°:对照组B组19例，主侧凸平均Cobb's角87.5°。〔结果〕两组无严重神经系统并发症。A组平均牵引18d（14〜22d）后主侧凸平均矫正46%14例肺

2、功能减退患者均改善。两组均行一期后路松解三维矫形术，术后C7〜S1偏移値、顶椎偏移矫正A组优于B组。A组主侧凸平均矫正55・2°，B组45・7°，A组优于6组（P<0.05）°A组平均随访40个月，B组平均随访42个月，末次随访两组平均冠状面矫正丢失分别为3°、2.4°，矢状面无丢失，两组均获骨性融合。〔结论〕对于柔韧性30%〜40%的重度脊柱侧凸，术前H“lo・股骨髀上牵引可改善肺功能，结合牵引下后路松解矫形术可以获得更好的畸形矫正和躯干平衡，减少术中术后并发症。【关键词】脊柱侧凸重度侧凸牵引后路矫形Abstract:[Obj

3、ective]TodiscusstheefficacyofHalo-femoraltractioncombinedwithposteriorsurgeryforidiopathicscoliosis.[Methods]Atotalof41patientswithsevereidiopathicscoliosis(flcxibilityof30%〜40%)fromJan.2000toJun.2006wereretrospectivelyreviewed.Thepatientsweredevidedinto2groupsaccord

4、ingtowhetherpreoprativetractionwasused(nl二22,n2二19respectively).TheaverageprcopcrativcCobb'sanglewas91.2°ingroupAand87.5°ingroupB.〔RcsulIs〕Nosevereneuralcomplicationswerenotedinbothgroups・TractionwasusedingroupAforanaverageof18daysbeforespinalfusion(range,14〜22days).

5、Aftertraction,thepatientsingroupAachievedameancorrectionof46%,and14ofthemwithpulmonaryfunctioncompromisegotrcspiratoryfunctionimproved.Al141patientsunderwentposteriorextensivereleaseandcorrection.ShorteroperativetimeandbetterC7PL・CSVLdistanceandAT(apicalvertebratran

6、slation)corretionwereachievedingroupA.Themajorcoronalcurvewasreducedby55.2°and45.7°afterposteriorspinalfusion,respectively.Theaveragelossofcorrectionwas3°formajorcoronalcurvesatanaverageof40・monthfollowingroupA,and2.4°atanaverageof42・monthfollow・upingroupB・Al1casesgo

7、tsolidbonyfusion・〔Conclusion〕Perioperativehalo・femoraltractioncanimprovepulmonaryfunctionandreduceoperativecomplicationsofseverescoliosiswithflexibi1ityof30%or40%.Betterdeformitycorrectionandtrunkbalancecanbeachievedbytractionasanadjuncltoposteriorextensivereleaseand

8、correction.Keywords:scoliosis；kyphosis；traction；posteriorcorrection牵引一直被作为重度侧凸的重要辅助治疗搭施，冃前僵硬性重度侧凸，或Cobb's角＞100°者凸侧侧屈位残留角度＞40°，或伴严重后