Clinical Study Of Preoperative Craniofemoral Traction For The Treatment Of Severe Rigid Scoliosis With Trunk Imbalance

Objective:Through retrospective analysis and comparison of the clinical data and data of patients with severe rigid scoliosis with trunk imbalance before operation,after operation,and follow-up,to compare the influence on deformity correction,overall trunk balance,shoulder balance with or without craniofemoral traction before and during the operation The,so as to provide clinical evidence for patients with trunk imbalance to take appropriate treatment.Methods:The data of patients with severe rigid scoliosis who completed operations in the Second Affiliated Hospital of Kunming Medical University from 2008 to 2020 were collected.A total of 48 cases met the inclusion and exclusion criteria,of which 27 cases in the traction group were given preoperative and intraoperative traction,and intraoperative osteotomy and pedicle screw internal fixation were perfoemed;21 cases in the non-traction group received intraoperative osteotomy and pedicle screw internal fixation.The general information of the included cases,the length of operation,the amount of blood loss,the number of fusion segments,the number of vertebral bodies removed,and the length of hospital stay were respectively compared and studied.According to the traction group(27 cases)and the non-traction group(21 cases)during the treatment process,the main scoliosis and kyphosis angles were compared respectively;according to the patient’s imbalance state,they were divided into coronal imbalance cases(39 cases):traction group(22 cases),non-traction group(17 cases);sagittal imbalance cases(24 cases):14 cases in traction group,non-traction group(10 cases);shoulder imbalance cases(29 cases):17 cases in traction group,non-traction group There were 12 cases.Before treatment,before operation,after operation,and during follow-up,the main scoliosis,kyphosis,C7 plumb line(C7PL)and center sacral vertical line(C7 plumb line,C7PL)and center sacral vertical line between and within each group of patients with imbalances,CSVL)spacing,sagittal vertical axis(SVA),X-ray shoulder height(Radiographic shoulder height,RSH)were compared according to the imbalance state;according to whether the scoliosis is greater than 120° and there is a coronal plane For patients with imbalance,compare the C7-CSVL between groups;according to whether the kyphosis is greater than 90° and patients with sagittal imbalance,compare the SVA between groups.Statistical analysis was performed on the above data using SPSS 25.0 software,and 2 tests were used for the gender,concomitant diseases,and deformity types of the two groups of patients;during the treatment,the mean±standard deviation(±standard deviation)of scoliosis,kyphosis,C7-CSVL,and SVA)Means using t-test and rank-sum test;age,follow-up time,operation time,number of vertebral bodies removed,surgical osteotomy grade,intraoperative blood loss,and number of fusion segments use median and interquartile range[M(P25～P75)]indicates that the rank sum test is used.P<0.05 means the difference is statistically significant.Results:According to the inclusion and exclusion criteria,there was no statistically significant difference between the two groups of patients before treatment in terms of gender,age,follow-up duration,type of deformity,and accompanying diseases.The difference was not statistically significant(P>0.05).The length of hospital stay in the traction group was 59(49～70)days and 32(28.5～55.5)days(P<0.05).The cobb angle of scoliosis in the traction group increased from 48.78°±11.50° after surgery to 50.41°±12.61° at the last follow-up,the difference was statistically significant(P<0.05).Before treatment,the unbalanced cases included coronal,sagittal,and shoulder imbalances.There were no significant differences in the main scoliosis,kyphosis and balance parameters(P>0.05);the unbalanced patients in the traction group after preoperative traction The deformity angle and trunk balance were better improved(P<0.05);the trunk imbalance and deformity angle of the patients in the postoperative traction group and the non-traction group were significantly improved(P<0.05),and the postoperative imbalance patients in the traction group and the non-traction group were significantly improved.There were no significant differences in the improvement of trunk imbalance and deformity angle between the traction groups(P>0.05).However,in patients with scoliosis greater than 120° and coronal imbalance,the postoperative C7-CSVL of the non-traction group improved significantly than that of the traction group(P<0.05),but there was no significant difference in C7-CSVL between the two groups at the last follow-up(P>0.05);In patients with scoliosis less than 120° and coronal imbalance,the improvement of C7-CSVL in the traction group was more significant than that in the non-traction group(P<0.05);in patients with kyphosis greater than 90° and less than 90° and sagittal imbalance,the traction group was compared with There was no significant difference in SVA between the non-traction groups(P>0.05).Compared between the traction group and the non-traction group,the traction group had shorter operation time,less intraoperative blood loss,reduced number of vertebrae removed,and lower surgical osteotomy grade(P<0.05).In terms of the number of vertebral body fusion segments,The difference was not statistically significant(P>0.05).In the traction group,there were 2 cases of traction-related complications and 7 cases of surgery-related complications,including 1 case of somatosensory evoked potential disappearance during surgical correction,2 cases of postoperative wound infection,3 cases of postoperative lung infection,and 1 case broke the rod during follow-up.There were 5 surgical-related complications in the non-traction group,including 1 patient with postoperative infection debridement,2 patients with broken rods found during postoperative follow-up,and 2 patients with distal decompensation after surgery.Conclusion(s):1.For severe rigid scoliosis in general,craniofemoral traction assisted surgery or simple posterior osteotomy has similar effects on restoring the overall balance of the spine and postoperative correction,but the craniofemoral traction assisted surgery to treat severely rigid scoliosis patients with scoliosis less than 120° and coronal imbalance,the improvement of coronal imbalance is more advantageous than surgery alone.2.The use of craniofemoral traction before and during operation can safely and effectively reduce the degree of preoperative deformity in patients with severe deformity,reduce the difficulty of operation,reduce intraoperative blood loss,and reduce the risk of operation.It is an effective auxiliary method for the treatment of severe spinal deformity.