發(fā)布時(shí)間：2018-03-21 20:44

  本文選題：Halo-股骨髁上牽引　切入點(diǎn)：后路矯形　出處：《中國(guó)矯形外科雜志》2017年19期 　論文類型：期刊論文

【摘要】：[目的]分析大重量Halo-股骨髁上牽引在治療重度僵硬性非特發(fā)性脊柱側(cè)凸中的矯形貢獻(xiàn)率及臨床意義。[方法]對(duì)2008年12月~2011年8月在本科住院并采用湘雅階梯漸進(jìn)式大重量Halo-股骨髁上牽引的26例重度僵硬性非特發(fā)性脊柱側(cè)凸患者進(jìn)行回顧性分析。所有病例術(shù)前均行Halo-雙側(cè)股骨髁上牽引,牽引2~4周后,術(shù)中維持牽引下行一期后路松解內(nèi)固定矯形植骨融合術(shù)。通過(guò)測(cè)量術(shù)前全長(zhǎng)站立正位、仰臥位Bending像,支點(diǎn)加壓位、牽引后、術(shù)后側(cè)凸Cobb角,對(duì)各矯形要素(Bending、支點(diǎn)加壓、牽引、手術(shù))絕對(duì)和相對(duì)貢獻(xiàn)率進(jìn)行統(tǒng)計(jì)學(xué)分析。[結(jié)果]牽引過(guò)程中未出現(xiàn)釘?shù)浪蓜?dòng)、感染等并發(fā)癥,術(shù)中及術(shù)后均無(wú)癱瘓、呼吸衰竭及死亡等并發(fā)癥,隨訪時(shí)間為(42~70)個(gè)月,平均為54.00個(gè)月;隨訪期間無(wú)斷釘、斷棒等現(xiàn)象發(fā)生。術(shù)前站立位主彎側(cè)凸Cobb角平均93.00°±18.90°(71.00°~121.00°),仰臥位Bending像平均為74.70°±20.04°(52.50°~106.00°),支點(diǎn)加壓位平均為68.90°±18.21°(48.00°~96.60°),牽引后平均為59.80°±15.82°(42.00°~79.80°),術(shù)后平均為40.60°±12.09°(23.00°~58.10°);各矯形要素(Bending、支點(diǎn)加壓、牽引、手術(shù))的絕對(duì)貢獻(xiàn)率為20.50%±6.02%、6.22%±3.29%、9.63%±5.42%、20.58%±8.61%,總貢獻(xiàn)率為56.83%±6.87%(51.50%~67.61%)。2例患者牽引過(guò)程中出現(xiàn)背部后凸處皮膚壓紅,5例出現(xiàn)不同程度膝、髖關(guān)節(jié)僵硬。[結(jié)論]在重度僵硬性非特發(fā)性脊柱側(cè)凸治療中,采用湘雅階梯漸進(jìn)式大重量Halo-股骨髁上牽引,矯形貢獻(xiàn)率相對(duì)突出,可有效地使矯形風(fēng)險(xiǎn)分散,降低手術(shù)風(fēng)險(xiǎn),是治療重度僵硬型非特發(fā)性脊柱側(cè)凸一種安全、有效的方法。
[Abstract]:[objective] to analyze the orthopedic contribution rate and clinical significance of high-weight Halo-femoral supracondylar traction in the treatment of severe stiff non-idiopathic scoliosis. A retrospective analysis was performed on 26 patients with severe rigid nonidiopathic scoliosis who underwent high weight Halo-femoral supracondylar traction. All patients were treated with Halo-bilateral supracondylar traction before operation. After 2 weeks of traction, the orthopedic bone graft fusion was performed with one stage posterior release and internal fixation during the operation. Bending images of standing position, supine position, fulcrum compression position, Cobb angle of postoperative scoliosis were measured before and after traction. The absolute and relative contribution rates of various orthopaedic elements, such as Bending, fulcrum compression, traction, surgery) were analyzed statistically. [results] there were no complications such as loosening of the nail canal and infection during traction, and no paralysis occurred during or after operation. Complications such as respiratory failure and death were followed up for 42 ~ 70 months with an average of 54.00 months. The mean Cobb angle of the standing position was 93.00 擄鹵18.90 擄/ 71.00 擄/ 121.00 擄/ m, the mean value of the supine position was 74.70 擄鹵20.04 擄/ 52.50 擄/ 106.00 擄/ m, the average value of the fulcrum pressure position was 68.90 擄鹵18.21 擄48.00 擄/ 96.60 擄/ m, the average value was 59.80 擄鹵15.82 擄/ 42.00 擄/ 79.80 擄and 40.60 擄鹵12.09 擄/ 23.00 擄/ 58.10 擄respectively. The absolute contribution rate was 20.50% 鹵6.02% 鹵3.29% 鹵9.63% 鹵5.42% 鹵8.61%, and the total contribution rate was 56.83% 鹵6.87% 鹵6.87% 鹵67.61%. During traction, 5 cases with kyphosis and 5 cases with hip stiffness. [conclusion] in the treatment of severe stiff non-idiopathic scoliosis, the total contribution rate is 56.83% 鹵6.87% 鹵67.61%. [conclusion] in the treatment of severe stiff non-idiopathic scoliosis, the total contribution rate is 56.83% 鹵6.87% 鹵67.61%. Using Xiangya step by step large weight Halo-femur supracondylar traction, the orthopedic contribution rate is relatively prominent, which can effectively spread the orthopedic risk and reduce the surgical risk. It is a safe and effective method for the treatment of severe stiff non-idiopathic scoliosis.
【作者單位】： 中南大學(xué)湘雅醫(yī)院脊柱外科湘雅脊柱外科中心;
【基金】：國(guó)家自然科學(xué)基金項(xiàng)目(編號(hào):81472145) 湖南省“芙蓉學(xué)者”項(xiàng)目
【分類號(hào)】：R687.3

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