| Objective:To design a "combined adjustable Halo-pelvic spinal traction device",which aims to meet the clinical needs of individualized treatment for severe rigid scoliosis deformity,and to evaluate the clinical efficacy and safety of one-stage continuous spinal traction combined with two-stage posterior column osteotomy for severe rigid scoliosis deformity.Methods:Based on the traditional Halo-pelvic spinal traction device,with modular design concepts,we developed a combined adjustable Halo-pelvic spinal traction device.The device consists of independent pelvic ring,Halo ring,pins and connecting rods.The stable frame structure formed by screwing the bone needle into the skull and the bone needle through the iliac bone,and then connected and stretched by special connection adjustment components.This study was approved by the Ethics Committee of the First Affiliated Hospital of Army Medical University.The study included 22 patients who were treated by a two-stage correction strategy(first stage: a preoperative Halo-pelvic spinal traction;second stage: a posterior-column osteotomy and pedicle screw instrumentation)from February 2015 to October 2018.Collect demographic variables,such as gender,age,height,weight and etiology before traction.All patients underwent combined adjustable Halo-pelvic traction at the first stage and posterior column osteotomy at the second stage.Some patients with severe thoracic deformity combined with thoracoplasty,and some patients with severe thoracic deformity combined with satellite rod technology.The whole spinal X-ray was taken preoperative,post-traction,post-operative and the last follow-up.The main curve Cobb angle,compensatory curve Cobb angle,thoracic kyphosis angle,main curvature deflection,thoracic trunk tilt,main curvature height,trunk height,radiographic shoulder height,clavicle angle,T1 tilt angle,pelvic tilt,sacral tilt and other radiographic parameters were measured and compared before and after treatment.The occurrence and prognosis of complications during traction and operation were observed and recorded.Statistical analysis was performed by using SPSS software(Version 22.0).The descriptive statistics of the measurement data are presented as the mean ±SD.A t-test was employed for analyzing the dates between the pre-HPT and the post-HPT,and a one-way analysis of variance(ANOVA)was used to compare the dates between the pre-HPT,post-HPT,post-operation and the last follow-up periods.The difference was considered statistically significant when P<0.05.Results:Clinical data: A total of 22 patients(F:M=16:6)were enrolled in this study,with an average age 18.5±9.9Y(11-48Y)and an average follow-up of 12.4 months(range: 3–36 months).The average traction duration was 8±2 weeks(range: 5-11 weeks).All patients` second-stage surgery consisted of a posterior-column osteotomy.For these procedures,3 patients were assisted with satellite rod technology and 6 patients were assisted with thoracoplasties.The mean fusion segment was 14.2±1.8(range: 9-17),the mean operative time was 256.8±49.6 min(range: 210-398 min)and the mean bleeding volume was 502.3±152.3 ml(range: 300-800 ml).The patients' height increased by 11.1 cm after traction.Clinical efficacy: Preoperatively,the mean main coronal Cobb angle was 122.4±15.0°(range: 90.6-148.3°),and the thoracic kyphosis angle was 79.7±28°(8.5-131.2°).Scoliosis that was observed on the Bending radiographs was corrected to 106.8±14.3°(range: 82.2-128.2°),with a Bending-flexibility of 12.8%(range: 3.6-22.8%).After traction,the main coronal Cobb angle was corrected to 72.1±23.4°,with a correction rate of 41.1%,and the thoracic kyphosis angle was corrected to 47.9±23.4°,with a correction rate of 39.9%.Postoperatively,the main coronal Cobb angle was further corrected to 56.4±23.6°,and t thoracic kyphosis angle was corrected to 46.2±19.3°,with a final correction rate of 53.9% for the coronal plane and 42% for the sagittal plane,respectively.There was a mild correction loss observed at the last follow-up.Tractive efficacy: The pre-HPT and post-HPT apical vertebra rotation of the main curve was 3.5±0.6 and 2.0±0.7,and the main curve heights in the coronal plane was 123.7±35.4 mm before traction and 188.7±42.1 mm after traction,the trunk height was 309.9±47.7mm before traction and 423.0±58.6mm after traction,and the thoracic trunk shift was 39.9±19.9mm before traction and 15.6±7.2mm after traction,which all displayed statistical significance.Preoperatively,the proximal compensatory Cobb curve was 55.3±17.3°,with a Bending flexibility of 34%,and the distal compensatory curve was 50.2±27.5°,with a Bending flexibility of 28.1%.After traction,the proximal compensatory curve was corrected to 36.8±13.3°,and the distal compensatory curve was corrected to 30.7±21.4°,and there was no difference between post-HPT and Bending radiograph.In terms of global balance,the coronal imbalance improved by 16.3 mm,or an improvement of 54.9%,and the sagittal imbalance improved by 18 mm,or an improvement of 55.2%,after HPT.When regarding the recovery of shoulder balance,we found an improved CA of 5.9°,or an improvement of 88.1%,an improved T1 tilt angle of 12.8°,or an improvement of 66%,and an improved RSH of 22.5 mm,or an improvement of 82.7%,after HPT.In regards to the recovery of pelvic balance,we observed an improved pelvic tilt of 2°,or an improvement of 34.5% and an improved sacral tilt of 4.4°,or an improvement of 36.4%,after HPT.Traction-related complications: The following HPT-related complications were observed in 7/22 patients: 4 patients suffered from pin tract cutting and infections,which was well cured after timely dressing changes,oral antibiotic treatments and debridement;2 patients had occurrences of transient cranial nerve paralysis,which responded well to the timely reduction of the traction height;1 patient suffered from traction failure due to needle loosening,which finished traction after replacing pelvic pins.Conclusions:1.Combined adjustable Halo-pelvic spinal apparatus can meet the individualized curative requirement of preoperative spine traction for patients with severe rigid scoliosis deformity.Modular design makes it much easier for clinical installation and adjustment.2.One-stage Halo-pelvic spinal traction may mainly focus on the main curve area in thoracolumbar region,gradually correct spinal deformity,increase trunk height,improve trunk sagittal,coronal and shoulder balance,and restore limitedly vertebral rotation,pelvic and sacral tilt.3.One-stage combined adjustable Halo-pelvic spinal traction combined with two-stage posterior column osteotomy is a safe and effective treatment strategy for severe rigid scoliosis,compared with the literature of three-column osteotomy represented by PVCR which can achieves satisfactory orthopedic effect and significantly reduces surgical trauma. |
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