摘要
目的通过与自体髂骨植骨融合术进行比较,探讨以同种异体骨加用自体肋骨取代自体髂骨在特发性胸椎侧凸后路矫形术中的应用效果。方法对1999～2000年间收治的有完整资料的84例特发性胸椎侧凸患者进行回顾性分析。A组(自体髂骨融合组)34例,年龄12～20岁,平均14.5岁;Cobb角40°～82°(平均56°),未行胸廓成形术,King分型Ⅱ型8例,Ⅲ型22例,Ⅴ型4例。B组(同种异体骨加自体肋骨融合组)50例,年龄13～19岁,平均15.4岁;Cobb角38°～80°(平均54°),King Ⅱ型14例,Ⅲ型30例,Ⅴ型6例。均采用后路CD、CDH 或TSRH固定。术后定期随访并进行影像学和临床融合状态评估。结果术后随访2～5年,平均3.4年。A组患者术后Cobb角平均矫形率为73.2%。随访2年时矫形丢失率为10%,假关节发生率为3%。取骨处的总体并发症发生率为26%,包括取髂骨处深部感染、血肿,伤口浅层愈合不佳,取髂骨处疼痛等。B组术后Cobb角矫形率为70.4%,随访2年时矫形丢失率为9%,假关节发生率为2%,TSRH钩-棒固定松动2例。胸廓成形术取肋骨的总体并发症发生率为20%,包括术中胸膜破裂,术后局部反常呼吸,渗出性胸膜炎,深吸气性疼痛等。结论同种异体骨加自体肋骨植骨若适应证选择恰当是一种安全、可靠、有效、经济的植骨方法,从融合率、矫形丢失。
Objective To compare the clinical outcomes of selective thoracic spinal fusion in adolescent idiopathic scoliosis using either iliac bone or autologous rib combined with allografts. Methods A retrospective study was made in 84 cases of idiopathic thoracic scoliosis, who were operated on with posterior instrumentation of CD, CDH or TSRH from 1999 to 2000. These patients were divided into two groups. In Group A, 34 patients, who were 12 to 20 years with a mean age of 14.5 years with a mean Cobb angle 56°(range, 40° to 82°), received autologous iliac bone grafting, and no thoracoplasty were performed. In group B 50 patients, who were 13 to 19 years with a mean age of 15.4 years with a mean Cobb angle of 54° (range, 38° to 80°), had allograft bone grafting combined with the ribs from thoracoplasty. The patients were followed up for at least 2 years with an average of 3.4 years regarding the clinical and radiographic outcomes. Results For group A, an average of 73.2% correction rate was achieved, and average 10% loss of correction and 3% of pseudoarthrosis was recorded at 2 year follow-up. The incidence of donor site morbidity was 26%, which included deep infection, hematoma, delayed healing of incision and continuous pain. For group B, an average of correction rate was 70.4% with 9% average loss of correction and 2% of pseudoarthrosis at 2 year follow-up. The complications related to thoracoplasty consisted of intraoperative tear of parietal pleural, pneumothorax, effusive pleuritis, and chest pain. Conclusion The clinical outcomes are comparable between the group of iliac bone grafing and the group of rib grafing associated with allografts in terms of fusion rate and loss of correction. If chose appropriately, allografts plus autologous rib harvested from thoracoplasty will be a good alternative to iliac crest regarding its safety, efficacy and reliability.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2004年第10期581-585,共5页
Chinese Journal of Orthopaedics
