PREOPERATIVE HALO-GRAVITY TRACTION WITH AND WITHOUT ANTERIOR RELEASE FOR SEVERE SCOLIOSIS

ABSTRACT Objective: This study aims to compare the use of halo-gravity traction (HGT) with and without previous anterior release, in terms of curve reduction, for the treatment of pediatric severe spinal deformity. Methods: From 2010 to 2016, all patients treated with HGT prior to instrumentation for scoliosis and kyphoscoliosis were reviewed. They were assessed by deformity etiology, previous anterior release, instrumentation procedure used, traction protocol, major Cobb angle before traction, after the protocol, and after the instrumentation procedure. Twelve patients met these criteria and constituted the sample groups: Group I (n=7) with anterior release and Group II (n=5) without anterior release. Results: The average pre-traction major curve Cobb angles were 114.9o and 108.4º for Group I and II, respectively (P>0.05). After HGT, both groups achieved a significant reduction in curve angle (P<0.05). Group I presented an average Cobb angle of 95.0o after HGT, representing a 17.3% (19.8o) curve reduction. Group II presented a Cobb angle of 80.1o, representing a 25.2% (28.4o) curve reduction. The difference between the two groups in relation to the reduction of major curve after HGT was not statistically significant (P=0.073). After the surgical procedure, the correction achieved was significantly improved (P<0.05), without statistically significant difference between the two groups (P>0.05). No major HGT related complications were reported. Conclusions: Anterior release prior to HGT did not increase major curve correction after posterior surgery for severe pediatric idiopathic and syndromic scoliosis. HGT is an effective and safe technique, though it frequently presents minor and transitory complications. Level of Evidence III; Retrospective Comparative Study.

摘要
研究目的：本研究以脊柱曲度矫正效果为评价指标，对比术前接受与未接受前路松解术的 halo重力牵引（halo-gravity traction, HGT）方案在儿童重度脊柱畸形治疗中的应用效果。
方法：2010年至2016年，本研究回顾性分析了所有在脊柱侧凸及脊柱侧后凸畸形内固定术前接受HGT治疗的患者资料，从畸形病因、术前前路松解史、所采用的内固定术式、牵引方案、牵引前、牵引方案结束后及内固定术后的主弯Cobb角（Cobb angle）多个维度对患者进行评估。最终共有12例患者符合纳入标准，被分为两组：组I（n=7）为术前接受前路松解术者，组II（n=5）为术前未接受前路松解术者。
结果：两组患者牵引前的主弯Cobb角平均值分别为114.9°与108.4°，组间差异无统计学意义（P>0.05）。经HGT治疗后，两组患者的脊柱曲度均得到显著矫正（P<0.05）；组I患者经HGT后的平均Cobb角为95.0°，曲度矫正率达17.3%（矫正绝对值为19.8°）；组II患者的平均Cobb角为80.1°，曲度矫正率达25.2%（矫正绝对值为28.4°）。两组患者经HGT后的主弯矫正幅度差异无统计学意义（P=0.073）。内固定术后，两组患者的畸形矫正效果均得到进一步提升（P<0.05），且组间差异无统计学意义（P>0.05）。本研究未报告与HGT相关的严重并发症。
结论：对于儿童重度特发性及综合征性脊柱侧凸，术前前路松解联合HGT并未提升后路内固定术后的主弯矫正效果。HGT是一种安全有效的治疗手段，尽管其常出现轻微且短暂的并发症。
证据等级：Ⅲ级；回顾性对比研究。