摘要
背景:脊柱侧凸矫正术中植骨融合技术是决定矫形治疗结果的关键因素之一。因自体骨应用受限,同种异体骨移植已广泛应用于临床。但同种异体皮质骨颗粒与同种异体松质骨颗粒在脊柱矫形患者中应用的实际效果是否一致?目的:比较不同种类骨移植在青少年特发性脊柱侧凸后路矫形植骨融合术中的应用效果。方法:2004年1月至2007年1月107例青少年特发性脊柱侧凸患者接受经后路脊柱侧凸矫形植骨融合手术。根据植骨材料不同分为A组(同种异体松质骨植骨,57例)和B组(同种异体皮质骨植骨,50例),比较两组患者随访第6、9、12、18、24、36个月的植骨融合情况、术后Cobb角变化情况及并发症等。结果:两组患者年龄、性别、主弯Cobb角、融合节段数及植骨量均无明显差异。平均随访时间为39.8个月。所有病例畸形明显矫正,术后1周总体矫正率为74.2%,最终随访总体矫正率72.1%。术后1周Cobb角及畸形矫形率,最终随访Cobb角、畸形矫形率及矫形度数丢失方面,两组相比均无明显统计学差异(P>0.05)。所有病例最终达到植骨骨性融合,A组平均融合时间15.0个月(6～36个月),B组平均融合时间15.9个月(6～36个月)。术后第6、9、12、18、24、36个月,两组骨性融合率均无明显统计学差异(P>0.05)。两组均未发生螺钉松动、断裂、断棒、假关节等并发症。术后A组4例(7.0%)、B组3例(6.0%)患者出现脑脊液漏,A组1例(1.8%)患者出现切口局部愈合障碍,均得到合理处理。结论:同种异体松质骨或皮质骨骨移植是脊柱侧凸后路矫形植骨融合术中较为理想的植骨方法之一,尤其是后者更是具有来源广泛、骨量大的优点。但在使用时,需根据同种异体骨骨愈合机制来制定术后治疗和康复计划,确保发挥复合骨移植在脊柱矫形术中的优势。
Background： In the surgery of scoliosis,the clinical result mostly depends on the technique of bone graft. Because of the limitations of autograft bone, allograft bone is accepted widely. But are there any differences of clinical outcomes between allogous cancellous grafts and allogous cortical grafts after surgery？ Objective： The aim of the study is to compare the clinical outcomes of different types of allograft bones in posterior spinal fusion for the treatment of adolescent idiopathic scoliosis. Methods： A retrospective control study was made in 107 cases of adolescent idiopathic scoliosis. The patients were treated with posterior instrumentation of screw-rod fixation system from January 2004 to January 2007 in our hospital. They were divided into two groups according to the different bone graft： allogous cancellous graft in 57 patients （group A） and allogous cortical graft in 50 patients （group B）. The fusion rate, the change of postoperative Cobb＇s angle and the complications were compared between the two groups at 6, 9, 12, 18, 24 and 36 months of follow-up. Results： There were no significant differences in terms of age, gender, Cobb＇s angle of main curve, the number of fused vertebrae and the volume of bone graft between the two groups. All the 107 patients were involved in the final analysis with an average follow-up of 39.8 months. The average correction rate at 1 week after surgery and at the final follow-up were 74.2% and 72.1%, respectively in all patients. There were no statistical differences of Cobb＇s angle and correction rate at 1 week after surgery, and Cobb＇s angle, correction rate and the loss of Cobb＇s angle at the final follow-up between the two groups （P0.05）. The bone fusion was observed in all the patients. The average fusion period was 15.0 months （range, 6 to 36 months） in group A and 15.9 months （range, 6 to 36 months） in group B. There was no statistical differenceof fusion rate at 6, 9, 12, 18, 24, and 36 months postoperatively between the tw
出处
《中国骨与关节外科》
2012年第5期382-388,共7页
Chinese Journal of Bone and Joint Surgery
基金
四川省科技厅支撑计划项目资助(2010SZ0161)
