生物骨材料混合自体髂骨修复寰枢椎可复性脱位:后路固定植骨融合

Biological bone mixed with autologous bone for reducible atlantoaxial dislocation via posterior reduction with bone graft fusion

背景:研究表明,腰椎融合中生物骨材料植骨与自体髂骨移植相当,却明显降低了二次手术的风险,同时能更好地改善椎体功能障碍指数。目的:评价生物骨材料混合自体髂骨在寰枢椎可复性脱位后路钉棒内固定植骨融合中的效果。方法:选择可复性寰枢椎脱位患者72例,其中男37例,女35例,年龄28-72岁,均施行寰枢椎后路钉棒内固定植骨融合,寰椎采用侧块螺钉或椎弓根螺钉固定,枢椎采用椎弓根螺钉、椎板螺钉或侧块螺钉固定,分2组进行植骨融合:试验组(n=34)采用生物骨材料混合自体髂骨颗粒植骨融合,对照组(n=38)采用自体髂骨移植融合。治疗后随访12个月,对比两组植骨融合率、疼痛缓解、颈椎功能恢复、颈椎活动度及并发症发生情况。结果与结论:随访12个月,所有患者寰枢椎脱位复位内固定满意,颈部切口均I/甲愈合,均获得良好的骨性融合,融合率达100%;两组疼痛、颈椎功能、颈椎曲度和活动度均较治疗前明显改善(P<0.05),两组间植骨融合率、颈椎功能、颈椎曲度和活动度比较差异均无显著性意义;试验组取骨量、疼痛缓解时间少于对照组(P<0.05)。结果表明,采用生物骨材料混合自体髂骨进行可复性寰枢椎脱位后路钉棒内固定并植骨融合,可迅速缓解疼痛,减少取骨量,植骨融合率良好,颈椎功能恢复良好。

BACKGROUND： Studies have shown that biological bone and autogenous lilac bone exhibit equivalent lumbar fusion effects, but the former one significantly reduces the risk of secondary surgery and contributes to improving vertebral dysfunction. OBJECTIVE： To evaluate the effect of biological bone mixed with autologous bone in posterior screw rod internal fixation with bone graft fusion for reducible atlantoaxial dislocation. METHODS： Seventy-two patients with recoverable atlantoaxial dislocation, including 37 males and 35 females, aged 28-72 years old, were all subjected to posterior atlantoaxial screw rod fixation with bone graft fusion： the atlas was fixed with lateral mass screw or pedicle screw, and the axis fixed with the pedicle screw, lamina screws or lateral mass screw. These patients were assigned into experimental group （n=34） undergoing biological bone mixed with autologous lilac particle bone graft fusion, or control group （n=38） undergoing autologous lilac bone graft fusion. Twelve months later, fusion rate, pain relief, cervical function recovery, cervical activity and complications were compared between the two groups. RESULTS AND CONCLUSION： After postoperatively 12 months, all patients were satisfied with aUantoaxial dislocation reduction, with a good bone fusion rate up to 100%, and their neck incision healed well by primary intention. The pain, cervical function, cervical curvature and activity were improved significantly in the two groups after treatment （P 〈 0.05）, but there was no significant difference between the two groups. Compared with the control group, the amount of bone mass taken from the patient and pain relief time were lower in the experimental group （P 〈 0.05）. Taken together, the biological bone mixed with autogenous lilac bone for reducible atlantoaxial dislocation via posterior screw rod internal fixation and bone graft fusion can rapidly relieve pain, reduce the amount of bone mass taken from patients, and achieve good fusion effect and cervical functional recovery.