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同种异体骨与自体骨填充椎间融合修复脊髓型颈椎病的比较 被引量:14

Allogenic versus autologous bone filled cages for cervical spondylotic myelopathy
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摘要 背景:目前用于颈椎前路的填充材料较多,以自体骨、同种异体骨多见,但自体骨取材引发供骨区出血、感染、术后疼痛等并发症被临床工作者逐渐重视。同种异体骨具有良好的生物相容性及安全性,可作为一种比较理想的融合器填充材料。目的:对比异体骨与自体骨填充椎间融合器结合钢板内固定在脊髓型颈椎病患者颈椎前路融合中的临床修复效果。方法:2012年1月至2013年6月对44例脊髓型颈椎病共44节段实施前路椎间盘摘除、椎间融合联合钢板内固定治疗,取颈前斜切口2.0-3.0 cm,切除椎间盘及后纵韧带,尽量保留终板。其中24例取自体髂骨填充椎间融合器,20例采用同种异体骨填充,以JOA评分、Odom’s疗效评定标准及X线射片评定两组疗效。结果与结论:两组患者均获得12-18个月随访。两组间术后并发症及JOA评分差异无显著性意义。临床疗效评定(Odom’s标准)优良率,同种异体骨组高于自体骨组,差异有显著性意义(P<0.05)。术后3,6个月同种异体骨组融合率较自体骨组低,12个月时两组融合率均为100%。影像学结果提示,术后3,6,12个月同种异体骨组与自体骨组融合节段椎间隙高度、前凸Cobb角之间差异无显著性意义(P>0.05)。提示同种异体骨作为椎间融合器填充材料,融合率与自体髂骨相似,并可维持颈椎生理曲度及恢复椎间隙高度,可作为理想的骨填充材料应用于颈椎前路手术。 BACKGROUND:There are many filing materials used in anterior cervical fusion. Autogenous bone and alograft bone account for a large proportion; however, autogenous bone induces many complications such as hemorrhage, infection and postoperative pain in the donor bone region, which has been attracted attentions gradualy. Alogeneic bone with good biocompatibility and safety can be used as a kind of ideal fusion filing material. OBJECTIVE: To compare the clinical efficacy of autogenous bone or allograft bone filled cage combined with steel plate in the anterior cervical fusion. METHODS A total of 44 patients (44 segments) with cervical spondylotic myelopathy underwent anterior cervical discectomy, interbody fusion combined with steel plate fixation from January 2012 to June 2013. An oblique anterior cervical incision, 2.5-3.0 cm, was made. The intervertebral disc and posterior longitudinal ligament were cut and the endplate was tried to be reserved. Then, the iliac bone from 24 cases was obtained for the interbody fusion, and allogeneic bone was used in 20 cases. Clinical efficacy was assessed with X-ray, Japanese Orthopaedic Association (JOA) grade and Odom's evaluation scale. RESULTS AND CONCLUSION: All patients acquired the follow-up of 12-18 months, and there were no significant differences between the two groups in the postoperative complications and JOA score. The excellent and good rate (Odom's standard) was significantly higher in the allogeneic bone group than the autogenous bone group (P 〈 0.05). After 3 and 6 months, the fusion rates in the allogeneic bone group were lower than those in the autogenous bone group and the fusion rates of two groups were 100% after 12 months. Imaging studies revealed that at 3, 6, 12 months after operation, there were no differences between the two groups in the intervertebral height and Cobb's angle (P 〉 0.05). These findings indicate that allogeneic bone has a fusion rate similar to the autogenous iliac bone in the treatment of cervical sp
出处 《中国组织工程研究》 CAS 北大核心 2015年第3期329-334,共6页 Chinese Journal of Tissue Engineering Research
基金 江苏省临床医学研究中心资助项目(BL2012004)~~
关键词 生物材料 骨生物材料 脊髓型颈椎病 同种异体骨 自体髂骨 前路椎间融合 Subject headings:Cervical Vertebrae Spinal Fusion Transplantation,Autologous Internal Fixators
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