Гало-гравітаційна тракція при лікуванні складних (>100°) сколіотичних деформацій хребта в дітей: огляд клінічних випадків

Abstract

Relevance. The definition of «complex spinal deformity» remains rather vague, but in most publications mark it as a deformation, which on average exceeds 100 degrees. Modern surgical practice of one-stage correction of complex spinal deformities includes performing osteotomies of the spine, which significantly improves the possibility of deformity correction, but also increases the risk of neurological complications and the volume of intraoperative blood loss. The aim. To improve the results of surgical treatment of patients with complex spinal deformities through the preliminary use of halogravitational traction and to establish an effective and safe algorithm for the treatment of complex spinal deformities in children. Materials and methods. During the period from 2008 to 2018, the Orthopedic and Traumatology Department of the National Children’s Specialized Hospital «OKHMATDYT» treated 48 children with complex spinal deformities (>100°) using halo-gravity traction. Of these, 32 are boys and 16 are girls. The average age of the patients was 12.9 years. The average Risser score was 4.2 (P>0.01). 27.1% of patients had type 1 deformity according to Lenke, type 2 – 54.1%, type 3 – 8.3%, type 4 – 6.4%, type 5 – 4.1%. Results and discussion. Using of halo- gravity traction for the preoperative reduction of spinal deformity and prevention of neurological disorders, the average duration of spinal traction application was 46 (P>0.01) days. A weight of 40–50% of the patient’s body weight was used. After the stage of halo-gravity traction, the spine was stabilized with a polysigmentary construction. Conclusion. Halo-gravity traction as a first stage of severe scoliotic spinal deformations treatment allows to increase the mobility of the vertebral column and to adjust spinal cord step by step for the next correction treatment. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. Key words: spinal deformity, halo-gravity traction, surgical treatment.