Halo重力牵引对伴呼吸功能障碍的重度僵硬性脊柱畸形青少年患者肺功能的影响

《中华骨与关节外科杂志》2019年1月第12卷第1期Chinese Journal of Bone and Joint Surgery VoL12, No.l, Jan. 2019临床论著文章编号：2095-9958 ( 2019 ) 01 -0030~05D 01：10.3969/j .issn .2095-9958.2019.01.007抓重力躬丨对15^^^■性脊柱崎形隋文渊1刘瀚忠i a 张伟1张鑫2邓耀龙3黄紫房4范恒伟3杨靖凡3王其飞5杨军林”(1.中山大学附属第七医院骨科，广东深圳518107;2.南方医科大学南方医院儿科，广州510000;3.上海交通大学新华医院小儿骨科，上海200000;4•中山大学附属第一医院脊柱外科，广州510080;5•安徽医科大学第二附属医院骨科，合肥230000)【摘要】背景:Halo 重力牵弓丨在伴有呼吸功能障碍的重度僵硬型脊柱畸形中的应用时间及二期手术矫形时机仍未完全 清楚。

目的：回顾性分析伴有呼吸功能障碍的重度僵硬性脊柱畸形患者接受Halo 重力牵引前后的肺功能情况，总结 其变化规律，为Halo 重力牵引后手术矫形时机的选择提供依据。

方法:选取2012年1月至2017年9月收治的重度僵 硬性脊柱畸形伴肺功能障碍患者48例，男19例，女29例，年龄7~16岁，平均(11.1±2.6)岁。

术前侧凸Cobb 角平均 114.3°±9.2°,后凸Cobb 角平均95.8°±18.9°。

所有患者均行一期Halo 重力牵引和二期手术矫正脊柱畸形。

根据牵引前 肺活量(VC)将所有患者分为中度呼吸功能障碍组(VC:40%~60%)和重度呼吸功能障碍组(VC<40%)。

牵弓丨前和牵 弓丨后3、6、12个月行肺功能检查，分析相关肺功能参数与牵弓丨后恢复时间的关系,牵引前、牵弓丨后患者自觉症状改善与 牵引后恢复时间的关系，明确Halo 重力牵引后手术矫形的适当时机。

结果:所有患者均随访12个月。

牵引后3个月， 患者的肺功能参数稍高于牵引前，动脉血气分析提示肺功能水平较牵引前略有改善，但差异无明显统计学意义(P> 0.05)。

牵引后6个月，重度呼吸功能障碍组和中度呼吸功能障碍组的肺功能参数于牵弓丨前CP< 0.05);动脉血气分析均提示肺功能水平显著高于牵弓丨前(P < 0.05)。

牵引后1年,所有患者的肺功能较 牵弓丨前、牵引后3个月显著改善(P <0.05),但与牵引后6个月水平相当(P>0.05);所有患者自觉症状均得到改善，动脉血气分析基本恢复正常。

牵引后各项肺功能参数变化率、患者自觉症状改善率均与恢复时间成正相关。

结论:重度僵 硬性脊柱畸形的青少年患者行Halo 重力牵引后6个月和12个月的肺功能显著高于牵引前和牵引后3个月，特别是牵 引前表现为重度呼吸功能障碍的患者。

牵引后6~12个月是二期矫形手术的适当时机。

【关键词】重度僵硬性脊柱畸形;呼吸功能障碍;Halo 重力牵引Effect of Halo gravity traction on pulmonary function in teenages with severe rigid spinaldeformity combined with respiratory dysfunctionSUI Wenyuan1, LIU Hanzhong1A , ZHANG Wei1, ZHANG Xin2, DENG Yaolong3, HUANG Zifang4, FAN Hengwei3,YANG Jingfan3, WANG Qifei5, YANG Junlin3*(1. Department of Orthopaedics, The Seventh Affiliated Hospital of S un Yat-Sen University, Shenzhen 518107, Guangdong;2. Department of P ediatrics, Nanfang Hospital, Southern Medical Univeisity, Guangzhou 510000;3. Department of Pediatric Orthopedics, Xinhua Hospital, Shanghai Jiao Tong University, Shanghai 200000;4. Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080;5. Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei 230000, China)【Abstract 】 Background: The appropriate duration of Halo gravity traction and optimal time of secondary surgical correction for severe rigid spinal deformities combined with respiratory dysfunction are still obscure. Objective: To retrospectively ana­lyze pulmonary function test (PFT) results in patients who suffered from severe rigid spinal deformity and respiratory dysfunc­tion and underwent Halo gravity traction, and to summarize the change rule and confirm the optimal time of corrective surgery. Methods: A total of 48 patients with severe rigid spinal deformity combined with obvious respiratory dysfunction treated be­tween January 2012 and September 2017 were enrolled in this study. There were 19 males and 29 females with a mean age of (11.1 ±2*6) years (range ，7-16 years). The average preoperative Cobb angle and kyphotic angle were 114,30±9,20 and 95.80± 18.9°, respectively. All the patients underwent Halo gravity traction followed by surgical correction. According to preoperative vital capacity (VC), they were divided into moderate (VC: 40%-60%) respiratory dysfunction group and severe (VC<40%) re­spiratory dysfunction group. The PFT parameters were measured before traction and at 3, 6 and 12 months after traction, in­cluding forced vital capacity (FVC), FVC percentage of the measured value and predicted value (FVG%), forced expiratory vol- ume in 1 second (FEV1) and FEV1 percentage of the measured value and predicted value (FEV1%). The relationship between postoperative recovery period and PFT parameters was analyzed, as well as the relationship between postoperative recovery pe­A共同第一作者* 通信作者:杨军林，E-mail: y junlin@Chinese Journal of Bone and Joint Surgery Vol. 12, No.l, Jan. 201931riod and preoperative and postoperative subjective symptom improvement. Results: All the patients were followed up for 12 months. At 3 months after traction, PFT parameters began to increase gradually, but no statistical difference was found as com­pared with preoperative parameters (P>0.05). At 6 months after traction, FVC, FVC%, FEV1 and FEV1% in both severe respi­ratory dysfunction group and moderate respiratory dysfunction group were significantly higher than those before traction (P< 0.05). At one year after traction, FVC, FYC%, FEV1 and FEV1% in all the patients were significantly higher than those before traction and at 3 months after traction (P<0.05), but were similar to those at 6 months after traction (P>0.05). Subjective symp­tom was obviously improved in all the patients. There was a positive correlation between the recovery time and change rate of postoperative PFT parameters and improvement rate of subjective symptoms. Conclusions: The pulmonary function in the teen­agers with severe rigid spinal deformity at 6 and 12 months after traction are superior to that before traction and at 3 months af­ter traction, especially in the patients with severe ventilatory disorders. So the optimal time for corrective surgery might be 6 to 12 months after traction.【Key words 】 Severe Rigid Spinal Deformity; Respiration disorder; Halo Gravity Traction观察参数[1°，11]，分析肺功能各参数与牵引后恢复时间的关系。