Dynamics of correction of complex scoliotic deformity in children using halo-gravity traction
Keywords:halo-gravity traction, scoliosis
Background. Spinal deformity is one of the common orthopedic pathologies of childhood. Today, according to medical statistics, 75 % of children aged 7–12 years are diagnosed with scoliosis. Scoliosis of III–IV degree with pronounced cosmetic and functional disorders is detected in 1.5–2 % of all cases. Treatment of severe scoliotic deformities in children remains a major challenge for a vertebrologist. Preoperative halo-gravity traction (HGT) can be one of the options for better correction of complex scoliosis and minimization of neurological complications associated with intraoperative loading. Materials and methods. Seventy-six patients aged 7 to 17 years with complex scoliotic deformities were exa-mined. There were two groups: I (experimental one) — 38 children in whom HGT was used together with developed tactics of staged surgical treatment; II (control one) — 38 children who underwent one-step surgical correction. Results. After halo-gravity traction, the deformity angle decreased statistically significantly (p < 0.001), on average by 36.5 ± 14.9°, the change in deformity in boys and girls occurred equally (p = 0.279). With age, the angle of scoliosis in children increased. After HGT, the angle of scoliosis in children under 13 years of age decreased on average to 67.6 ± 14.7°, in patients over 14 years — to 85.9 ± 18.2°. In children under the age of 14, a reduction in the deformity angle was significantly greater, on average to 38.9 ± 13.2°, while in those older than 14 years, it did not reach 30° (27.5 ± 18.6°). HGT is more effective under 14 years of age than in older children. Patients in group I before surgical correction of scoliosis had a statistically significantly (p < 0.001) lower deformity angle than individuals in group II (106.0 ± 4.5°). After surgical correction, the angle of deformity in group I (44.4 ± 15.3°) was significantly (p < 0.001) lower than in children of group II (56.9 ± 14.2°), a reduction in spinal deformity was statistically significant (p < 0.001) in both groups. It was found that in children over 14 years of age, the correction of deformity was statistically significantly less (α = 0.05) than in younger patients, and this was observed in both groups. In group I, the percentage of deformity correction in children aged 7 to 13 years was statistically close (p = 0.181), but in group II, among patients aged 11 to 13 years, it was significantly lower than in children younger than 10 years. Conclusions. After halo-gravity traction in children, the scoliosis angle decreased statistically significantly (p < 0.001), by an average of 36.5 ± 14.9°, which is 34.0 ± 14.1 % of the deformity correction. The dynamics of correction does not depend on the sex of children (p = 0.824). The deformity angle in patients of group I (halo-gravity traction) before surgical correction was statistically significantly less than in group II. This resulted in a statistically significantly (p < 0.001) better outcomes of surgical correction in group I (59.4 ± 13.1 %) than in group II (46.6 ± 12.3 %). Regardless of the treatment protocol, the better results of scoliosis correction were observed in children under 14 years of age.
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