同种异体与自体骨移植治疗脊柱侧凸的前瞻性研究

Application of allograft bone for posterior spinal fusion in scoliosis

目的探讨同种异体骨移植在脊柱侧凸后路融合术中的使用效果.方法自1995年3月～2000年3月,前瞻性对60例脊柱侧凸患者行同种异体骨或自体骨移植后路矫形融合术,男19例,女41例.将其随机分为A组(30例)单纯使用同种异体骨移植和B组(30例)采用自体髂骨移植.A组中先天性脊柱侧凸16例、特发性脊柱侧凸12例、神经纤维瘤病和马凡氏综合征各1例.手术时平均年龄14.5岁(6～32岁),术前胸弯平均86.6°(47°～116°),平均融合节段8个(4～10个).B组中先天性脊柱侧凸15例、特发性脊柱侧凸9例、神经纤维瘤病5例、马凡氏综合征1例.手术时平均年龄13.7岁(11～21岁),术前胸弯平均77.8°(42°～101°),平均融合节段7个(5～10个).对两组患者的平均手术时间、失血量、并发症、矫形丢失进行对比分析.结果术后随访2～6年,平均4年5个月.与B组相比,A组患者手术时间明显缩短,失血量大大减少.最终随访时,A组平均Cobb角为44°(31°～73°),平均丢失8°;B组平均Cobb角为41°(24°～68°),平均丢失6°.A组和B组中分别有3例和2例患者出现了假关节.A组有1例患者出现伤口浅表感染.在平均矫形丢失和并发症发生率方面两组之间差异无显著性意义(P>0.05),但B组中有6例出现了供骨部位疼痛.结论在脊柱后路融合术中,尤其需要大量骨移植时,同种异体骨移植可以取得满意的临床效果.

Objective To investigate the efficacy of allograft bone in posterior spinal fusion in scoliosis. Methods From March 1995 to March 2000, 60 patients with scoliosis, who underwent posterior spinal instrumentation and fusion using allograft or autograft bone, were evaluated prospectively. All of the patients were randomized into group A (30 cases using only allograft bone) and group B(30 cases using autograft iliac bone).Among the patients in group A, there were 16 with congenital scoliosis, 12 with idiopathic scoliosis, 1 with neurofibromatsis scoliosis and Marfan syndrome respectively. The average age at surgery was 14 years 6 months. the average preoperative major curve was 86.6° with an average number of 8 fused segments (range, 4 to 10 segments). Whereas in group B, there were 15 with congenital scoliosis, 9 with idiopathic scoliosis, 5 with neurofibromtasis scoliosis and 1 with Marfan syndrome. The average age at surgery was 13 years and 8 months. The average preoperative major curve was 77.8° with an average number of 7 fused segments (range, 5 to 10 segments). The mean operative duration, average blood loss, complications and loss of correction between the two groups were analyzed comparatively. Results Each patient had a minimum 2-year follow-up with an average duration of 4 years 5 months. Group A was better than group B by a shorter operative duration, less blood loss. At last follow-up, the major curve measured an average of 44° (range, 31° to 72°) in group A and 41° (range, 24° to 68°) in group B respectively. There were 3 (10%) and 2 (6.7%) pseudoarthrosis occurred in group A and group B respectively. One superficial infection developed in group A. There was no significant difference of the average loss of correction and complication rate between the 2 groups. But there were 6 patients who had donor site pain in group B. Conclusion A satisfactory outcome can be achieved in posterior spinal fusion in scoliosis using allograft bone especially when a large amount of bone graft is needed.