| Objective: Through a retrospective study,we analyzed the clinical data and data of patients with severe spinal deformities during the traction process,analyzed the clinical differences between skull-femoral traction and halo-gravity traction,halopelvic traction as an auxiliary treatment for patients with severe spinal deformities,and focused on exploring the impact of skull-femoral traction on the overall condition and deformity status of patients with severe spinal deformities and its efficiency.To further compare the differences in the efficacy of skull-femoral traction in patients with different morphological types and different vertex positions.To provide strategies for preoperative traction and adjuvant treatment of patients with severe spinal deformities.Methods: Data of patients with severe spinal deformities hospitalized in The Second Affiliated Hospital of Kunming Medical University from January 2015 to December 2020 were collected(A total of 63 cases were treated with skull-femoral traction in 51 cases,halo gravity traction in 9 cases,and halo pelvic ring traction in 3 cases).First,the clinical differences in the improvement of deformity,pulmonary function,and nutritional status of patients with severe spinal deformities treated with three different preoperative traction methods were analyzed.The focus of this study was to explore the time-effect relationship of Cobb angle improvement in the main curvature of patients undergoing skull-femoral traction at the first and second weeks,as well as the characteristics of changes in pulmonary function and nutritional status before and after traction.Further,patients with severe spinal deformities were classified into standard vertebrae according to their full length X-ray morphology(scoliosis type spinal deformities,kyphosis type spinal deformities,angular spinal deformities)and the position of the top vertebrae(T1-11,T12/low).Comparative studies were conducted on general data,imaging data,nutritional status,pulmonary function,and intraoperativeconditions of patients in different groups.SPSS 26.0 software was used for statistical analysis of the above data.Chi-square test was used for counting data such as gender and concomitant diseases.Measurement data that conformed to the normal distribution were expressed as mean ± standard vertebral deviation(x±s).T-test and ANOVA test were used.Data that did not conform to the normal distribution or had fewer cases were expressed as median and quartile intervals(M [P25,P75])or mean,minimum,and maximum values(M(Min,Max)),Rank sum test was used.P<0.05 indicates a statistically significant difference.Results: 1 The traction time of patients with skull-femoral traction before surgery was significantly shorter than that of patients with Halo-gravity traction and Halo-pelvic traction,with a statistically significant difference(P<0.05);The improvement rates of coronal/sagittal Cobb angle after skull-femoral traction were(8.3 ± 4.5)% and(14.5 ± 1.9)%,while the improvement rates of halo-gravity traction were(29 ± 11.4)% and(32.6 ± 18.4)%.The improvement rates of halo-pelvic traction patients were(39.9 ± 6.5)% and(37 ± 18.3)%.2 The improvement rates of Cobb angle in the coronal/sagittal main curvature were(21.7 ± 10.1)% and(21.5 ± 13.4)% after 1 week of traction in patients with skull-femoral traction,(26.4 ± 11.2)% and(29.4 ± 17.7)% at 2 weeks,and the postoperative improvement rates were(46.1 ± 13.3)% and(50.8 ± 15.3)%.Changes in lung function: The average values of FVC,FEV1,and FEV1% in patients with skull-femoral traction after traction increased compared to those before traction,with a statistically significant difference(P<0.05).Changes in nutritional status: After traction,the average values of albumin,lymphocyte count,and lymphocyte percentage decreased,while the average values of prealbumin increased,with a statistically significant difference(P<0.05).3.1 Comparison of skull-femoral traction in patients with different shapes: The improvement rate of coronal/sagittal Cobb angle in SS type patients is the highest,with(30.1 ± 10)% and(39.5 ± 23.5)% respectively,while the improvement rate of sagittal malformation in AD type patients is the lowest.Changes in pulmonary function: Patients with KS type had the worst pulmonary function,but after skull-femoral traction,FVC and FEV1 improved significantly,with a statistically significant difference(P<0.05).Changes in nutritional status: After traction,albumin,lymphocyte count,and lymphocyte percentage decreased in patients with three different forms,among which there was a statistically significant difference in albumin and lymphocyte count in patients with AD type before and after traction(P<0.05).3.2 Comparison of skull-femoral traction in patients with different vertex positions: There was a statistically significant difference in body mass index,coronal Cobb angle,and sagittal plane deformity rate between the two groups(P<0.05),but there was no statistically significant difference in the improvement rate of coronal/sagittal plane deformity after traction for 1 week,2 weeks,and after traction(P>0.05).Changes in pulmonary function: After traction,the average values of FVC,FEV1,and FEV1% in patients with a vertex located at T1-11 increased compared to those before traction,with a statistically significant difference(P<0.05).Changes in nutritional status: After traction,both showed a significant decrease in albumin,lymphocyte count,and lymphocyte percentage(P<0.05).4 Traction complications: During traction,6 patients in the traction group experienced traction related complications: among them,3 patients with skull-femoral traction experienced decreased pain sensation,1 patient experienced decreased muscle strength,and symptoms relieved after weight reduction;Among the patients with halogravity traction,1 patient experienced loosening of the nail track,and 1 patient with halo-pelvic traction experienced digestive dysfunction and decreased muscle strength.None of the patients experienced permanent neurological damage.Conclusion:1 Among the three traction methods,the time of skull-femoral traction is significantly shorter than that of Halo-gravity traction and Halo cephalopelvic ring traction,with the lowest improvement rate of halo-gravity traction deformity and the highest Halo cephalopelvic ring traction.2 The patients with 2 rows of skull-femoral traction had the highest improvement efficiency within 1 week.skull-femoral traction can improve lung function in patients,but it can reduce albumin and lymphocyte counts in patients.3 The improvement rate of coronal traction deformity in patients with severe spinal deformities of SS,KS,and AD before surgery is similar,but there is a difference between the improvement rate of sagittal traction deformity in patients with SS and AD.The location of the top vertebra in the thoracic or thoracolumbar/lumbar spine has no significant impact on the improvement rate of skull-femoral traction deformity in patients. |
