Analysis of the rate of orthopaedic contribution of strong halo-femoral traction in the treatment of severe rigid idiopathic scoliosis

Abstract

Objective To analyze the rate of orthopaedic contribution of strong halo-femoral traction in the treatment of severe rigid idiopathic scoliosis and discuss its meaning. Methods All of 27 cases of severe rigid idiopathic scoliosis patients treated with strong halo-femoral traction, hospitalized in our department from December 2008 to August 2010, were retrospectively analyzed. All patients underwent preoperative Halo-femoral traction. After 2-4 weeks' traction, one-stage posterior instrumentation and fusion was performed with intraoperative traction. The Cobb angles in coronal plane of the major curve before surgery, on bending film, on fulcrum film, after traction and immediately after surgery were measured. The rate of absolute and relative contribution of every orthopaedic element (Bending, fulcrum, traction, surgery) were compared. Results The duration of follow-up was (51.8±7.7) months on average (range, 40-68 months). The mean coronal Cobb angle of major curve were 105.1°±11.1°(88°-131°), the mean coronal Cobb angle of major curve on Bending film were 84.6°±12.6°(69°-115°), and the mean coronal Cobb angle of major curve on fulcrum film were 75.8°±10.5°(62°-97°). The mean coronal Cobb angle of major curve after traction were 66°±11.7°(50°-90°). The mean coronal Cobb angle of major curve after posterior surgery were 43.1°±8.8°(23°-58.1°). The mean correction rate after traction was 37.5%±6.4%(28.6%-54%) ,the correction rate after surgery was 57.2%±6.7% (51.5%-67.7%) on the aver-age. The rate of absolute and relative contribution of Bending were 19.8%±4.4%(12.2%-28.1%) 、33.8%±7.6%(21.4%-46.2%). The rate of absolute and relative contribution of fulcrum were 8.2%±4.3%(2.9%-24.8%) 、13.3%±6.9%(1.1%-35.5%). The rate of absolute and relative contribution of traction were 9.5%±4.7%(2%-20%) 、16.2%±8.2%(3.4%-36.5%). The rate of absolute and relative contribution of surgery were 21.7%±7.0% (5.9%-37.2%) 、36.7%±10.7%(11.6%-55.6%). In the process of traction one patient had the right little finger numb and two other patients experienced stiff knee and hip, there were no other related complications occurring in the process of traction. No death or respiratory failure or paralysis occurred intra- and post-operatively. No screw or rod fracture was found during the follow-up. Conclusion The study indicates that the XiangYa gradual strong halo-femoral traction makes relatively prominent role in the treatment of severe rigid idiopathic scoliosis, meanwhile makes the correction diversification, reduces the risk of operation, effectively avoids many unnecessary VCR, and is a safe and effective way for the treatment of severe rigid idiopathic scoliosis. Key words: Scoliosis; Traction; Spinal Fusion