Severe Rigid Kyphoscoliosis: the Value of Halo-Vast orHalo-Gravity traction
重度僵硬性脊柱侧凸是指站立位冠状面Coob角>60°～100°, Bending像相柔韧性<30%。即使采用分期治疗或全脊椎截骨技术, 矫正率也很难超过60%[1] 。
1967 年Kane等［2］首次报道了应用Halo股骨髁上牵引治疗脊柱侧凸患者后，Halo胫骨牵引、Halo骨盆牵引、Halo重力牵引等被应用于脊柱畸形的治疗［3-6］。研究表明应用牵引技术治疗重度僵硬性脊柱侧凸可以改善此类脊柱畸形，且安全有效[7-9]。术前牵引可以减少直接行矫形手术所引起的神经损伤［10］。
但是关于牵引是否能改善脊柱畸形最终的矫形率存在争议，一部分学者认为［11-13］无论术前是否行牵引治疗，侧弯畸形术后矫形率的比较无统计学意义。但Koptan等学者［14-16］的相关研究证明严重僵硬特发性脊柱侧弯患者，牵引明显提高了术后的矫形率，并改善患者的肺功能［17-19］。虽然牵引技术可有效治疗重度僵硬性脊柱侧凸，降低神经并发症，减少不必要的脊椎截骨，改善肺功能，然而牵引可能带来的并发症是不能被忽视的。如感染、关节僵硬、第Ⅵ对脑神经损伤等，严重的可至截瘫［20］。
既然头盆环牵引存在诸多并发症，那么，您认为：目前应用术前头盆牵引治疗重度僵硬性脊柱侧后凸在改善脊柱柔韧性、肺功能，提高矫形率；减少截骨范围及术中神经损伤、预防术后肺部并发症等方面存在应用价值吗？应用中有哪些注意事项吗？
专题组织人：郑召民教授 史亚民教授
1.HustedDS,Haims AH,Fairchild TA,et al.Morphometric comparison of the pedicle rib unitto pedicles in the thoracic spine[J].Spine,2004,29:139-146.
2.Kane WJ,Moe JH,Lai CC.Halo-femoral pin distraction in the treatment ofscoliosis［J］.J BoneJoint Surg Am,1967,49:1018-1019．
3.Dewald RL,RayRD.Skeletal traction for the treatment of severe scoliosis the University ofIllinois halo-hoop apparatus［J］.J Bone Joint Surg Am,1970,52(2): 233-238．
4.Stagnara P.Cranial traction using the“Halo”of Rancho Los Amigos［J］.Rev Chir Orthop Reparatrice Appar Mot,1971,57(4):287-300．
5.Mehlman CT，AL-SayyadMJ，Crawford AH. Effectiveness of spinalrelease and halo-femoral traction in the management of severe spinal deformity［J］.JPediatr Orthop,2004,24:667-673.
6.Qian BP,Qiu Y,Wang B，Brachialplexus palsy associated with halo traction before posterior correction insevere scoliosis［J］.StudHealth Tech Inform,2006,123: 538 -542.
7.WatanabeK,Lenke LG,Bridwell KH,et al.Efficacu of perioperative halo-gravity tractionfor treatment of severe scoliosis(>/=100 degress).J OrthopSci,2010,15:720-730.
8.SponsellerPD,Takenaga RK,Newton P,et al.The use of traction in the treatment of severespinal deformity.Spine(Phila Pa 1976),2008,33(21):2305-2309.
9.ZhangHQ,Wang YX,Guo CF,et al.Posterior-only surgery with strong halo-femoraltraction for the treatment of adolescent idiopathic scoliotic curves more than100°.Int Orthop,2011,35(7):1037-1042.
10.NoordeenMH,Garrido E,Tucker SK,et al.The surgical treatment of congenitalkyphosis.Spine(Phila Pa 1976),2009,34(17):1808-1814.
11.Flierl S,CarstensC.The effect of halo-gravity traction in the preoperative treatment ofneuromuscular scoliosis［J］.Z Orthop Ihre Grenzgeb,1997,135(2): 162-170．
12.Seller K,Haas S,Raab P,et al.Preoperative halo-traction in severe paralytic scoliosis［J］.ZOrthop Ihre Grenzgeb.2005.143(5):539-543．
13.LjiljanaBogunovic, MDa, Lawrence G. Lenke, MD,et al.Preoperative Halo-Gravity Tractionfor Severe Pediatric Spinal Deformity: Complications, Radiographic Correctionand Changes in Pulmonary Function.Spine Deformity 2013(1)33-39.
14.Koptan W，ElMiliguiY.Three-staged correction of severe rigid idiopathic scoliosis using limitedhalo-gravity traction［J］.Eur Spine J,2012,21(6):1091-1098.
15.QiuY,Liu Z,Zhu F,et al.Comparison of effectiveness of halo-femoral traction afteranterior spinal release in severe idiopathic and congenital scoliosis:aretrospective study[J].J Orthop Surg Res,2007,2:23.
16.Koptan W，ElMiliguiY． Three-staged correction of severe rigididiopathic scoliosis using limited halo-gravity traction［J］.Eur Spine J,2012,21(6):1091-1098.
17.Watanabe K,Lenke LG,Bridwell KH,et al. Efficacy of perioperative halo-gravity traction fortreatment of severe Scoliosis(≥100°)［J］.JOrthop Sci.2010.15( 6): 720-730．
18.Nepple JJ,LenkeLG.Severe idiopathic scoliosis with respiratory insufficiency treated withpreoperative traction and staged anteroposterior spinal fusion with a 2-levelapical vertebrectomy［J］.Spine J.2009.9(7):e9-e13．
19.Koller H,Zenner J,Gajic V,et al.The impact of halo-gravity traction on curve rigidityand pulmonary function in the treatment of severe and rigid scoliosis andkyphoscoliosis: a clinical study and narrative review of the literature［J］.EurSpine J.2012.21(3):514-529．
20.Watanabe K,Lenke LG,Bridwell KH,et al.Efficacy of perioperative halo-gravity traction fortreatment of severe Scoliosis(≥100°)［J］.JOrthop Sci,2010,15( 6): 720-730
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