Clinical Study On Preoperative Cranio-Femoral Traction To Reduce The Risk Of Severe Scoliosis

【Objective】 To investigate the significance of skull-femur traction in the treatment of severe idiopathic scoliosis by retrospective paired analysis of patients with or without traction before operation.【 Method 】 Data of patients with severe idiopathic scoliosis(SIS)who received surgical treatment in our center from 2007 to 2019 were selected for retrospective pairing analysis.Matching criteria included: They were divided into traction group(24 cases)and non-traction group(24 cases)according to their age,gender,main curve Cobb Angle and BMI.The traction group underwent craniofemoral traction and intraoperative traction before surgery,and underwent osteotomy and orthosis and vertebral screw fixation after surgery.The non-traction group underwent osteotomy and orthosis and internal fixation of vertebral arch screw.General data,including BMI,etiology,neurological symptoms,Cobb Angle,SVA,CSVL-C7 VL,orthopedic rate,fusion segment,osteotomy grade,blood loss,operative time,FS value,etc.,were collected from the two groups【Results】 According to the inclusion and exclusion criteria,48 patients with severe rigid scoliosis who underwent cranio-femur traction before surgery in our center and underwent orthopaedic surgery for spinal deformity were collected.There was no statistical significance in gender,age,etiology and other general conditions between the two groups(P>0.05).Comparison between the two groups: 1.There was no significant difference in preoperative main curve Angle,FS value,coronal plane and sagittal plane balance and other basic imaging parameters(P> 0.05).The main curve,coronal plane and sagittal plane morphological parameters were similar between the two groups,but there was no statistical significance(P> 0.05).2.Intraoperative conditions: The mean SRS-Schwab osteotomy grade applied in the traction group was significantly reduced from grade 5.0 in the non-traction group to grade 3.9(P=0.006).The average operation time in traction group was significantly lower than that in non-traction group(P=0.05).The fusion segments were similar between the two groups(P > 0.05).Postoperative coronal position correction rate,CSVL-C7 PL and SVA were not significantly different between the two groups(P> 0.05).3.Complications: There were only 4 cases(16%)in the traction group,including 1 case of superficial surgical site infection and 3 cases of pulmonary infection,and no positive incidence of nervous system in the traction group during the operation.However,10 cases(41.6%)of complications occurred in the non-traction group,including 1 case of internal fracture,2 cases of superficial surgical site infection,1case of deep surgical site infection,5 cases of pulmonary infection,and 1 case of neurological complications.In the non-traction group,the amplitude of SSEP decreased by more than 50% during grade 5 osteotomy and orthosis,and the MEP disappeared completely,which gradually recovered by improving the spinal suxxation and reducing the spinal cord tension.Neurologic function was completely normal in post-operative arousal tests.4.Comparison of FS values: There was no significant difference in FS value of patients’ basic condition factors(BMI,neurological symptoms,etiology)and main curvature Angle between the two groups.There was no significant difference in FS value of operation-related factors(fusion segment,osteotomy grade,surgical method)between the two groups(P > 0.05).FS value in the traction group was always lower than that in the non-traction group,and the total score difference was statistically significant(p < 0.05)..【Conclusion】1.Traction assisted treatment of severe idiopathic scoliosis can effectively reduce the grade of osteotomy,reduce operation time and surgical bleeding,and improve the orthopedic effect and safety.2.Preoperative cranio-femoral traction can reduce the risk of scoliosis and reduce the incidence of complications.