中华长城内固定系统及同种异体骨融合治疗青少年脊柱侧弯畸形

China Great Wall System and allogeneic bone merged to treat scoliosis of teenagers

目的:针对于自体骨供区有限,采用中华长城系统内固定,自体骨与冷冻保存的同种异体干燥骨联合移植对青少年脊柱侧弯的改善。方法:选择2002-03/2004-05华中科技大学同济医学院附属荆州医院骨科收治的青少年特发性脊柱侧弯患者18例,Cobb’s角48°～110°,旋转畸形2°～3°。按King分型,Ⅰ型5例,Ⅱ型6例,Ⅲ型6例,Ⅳ型1例。所有患者术前均行颈椎牵引2周,术前1d预防性应用抗生素,内固定物采用中华长城内固定系统。术前2h将异体皮质、松质骨片放入37℃庆大霉素生理盐水中浸润,将骨片周边的皮质骨去除后,将松质骨片剪成2～6mm的碎松质骨粒,用37℃温生理盐水反复冲洗,继续放入37℃庆大霉素温生理盐水中进一步浸润待使用。Ⅰ型患者经横突旁切口行侧前路胸、腹膜外松解,矫形椎体钉固定、自体骨、冷冻保存的同种异体干燥骨混合后椎体间植骨术。Ⅱ,Ⅲ,Ⅳ型患者行后路椎弓根系统内固定,侧突变后突、分段撑开、剃刀背切除、自体骨、冷冻保存的同种异体干燥骨混合后椎板间植骨融合术。术后3周戴支具下地活动。结果:纳入患者18例,平均随访11.8个月,均进入结果分析。①手术一般情况:本组病例术中出血量为400～800mL,手术时间为3～6h,平均4.6h,术中唤醒检测脊髓均未见异常,伤口均为I类切口,甲级愈合。②手术前后cobb角矫正情况:与术前比较,术后1年侧凸主弯、代偿弯cobb角均明显减小[(68.3±12.6)°,(30.1±10.4)°;(31.2±9.5)°,(16.8±11.4)°;P均<0.05]。③顶椎旋转度矫正情况:与术前比较,术后1年明显减小[(2.4±0.5)°,(1.8±0.6)°,P<0.05]。④身高变化情况:与术前比较,术后1年明显增高[(146±19.2),(152±18.7)cm,P<0.05]。⑤植骨融合情况:所有病例在术后4个月,植骨颗粒已经模糊,开始形成新骨;术后8个月左右,已经有大量新骨形成,使得脊椎的正常结构已显示不清。无1例出现内固定物松动、断裂。均未出现3周后晚期感染以及因使用同种异体骨而感染肝炎或艾滋病者。结论:实验过程18例患者均未见明显排斥反应,切口愈合良好,植骨区均达骨性融合。提示中华长城内固定系统及同种异体骨融合对治疗青少年脊柱侧弯具有很好的稳定性。

AIM： Since the donor site of autogenous bone is limited, using China Great Wall System, autogenous bone and freeze-dried allogeneic bone are used in treating scoliosis of teenagers, observing its deformity and the improving situation. METHODS： Eighteen teenagers with idiopathic scoliosis, 48°-110°of Cobb＇s angle and 2°-3°of rotated deformity, were enrolled in the study, who admitted to Jingzhou Hospital from March 2002 to May 2004. According to King＇s typing, there were 5 cases of Ⅰ type, 6 of Ⅱ type, 6 of Ⅲ type, and Ⅰ of Ⅳ type. Preoperatively the cervical vertebra in all patients was drawn for 2 weeks, and antibiotic was adopted preventatively one day before operation. China Great Wall System was used in the operation. The xenogenic cortical and spongy bone flaps were infiltrated in normal saline containing gentamicin at 37℃ before operation. Then after getting rid of cortical bone around, spongy bone flaps were cut into grains 2-6 mm in length, rinsed repeatedly in normal saline at 37℃, and sequentially infiltrated in the gentamicin normal saline of 37℃ prepared for use further. Patients of type Ⅰ underwent lateral anterior release outside breast and peritoneum via the nick aside transverse process, fixation of vertebra body nail, and autogenous bone and freeze-dried allogeneic bone were used in the fusion of vertebral bodies. Internal fixation of pedicle screw system and resection of razor back were performed in patients of Ⅰ ,Ⅱ, Ⅲ, Ⅳ type. Then autogenous bone and freeze-dried allogeneic bone were used in the fusion between the vertebral plates. All patients had could walk wearing brace. RESULTS： Totally 18 patients were enrolled in the result analysis, and followed-up averagely for 11.8 months. ① General situation of operation： The bleeding amount was 400-800 mL, and operation time was 3-6 hours, average 4.6 hours. All patients were waked up to measure the spinal cord and had not abnormality in the operation. The wounds were Ⅰ notches, with first rate healing. ② The situation of corrected Cobb＇s angle after operation： Compared with before operation, the Cobb＇s angle of main curve and compensatory curve was reduced apparently 1 year after operation [（68.3±12.6）°, （30.1±10.4）°; （31.2±9.5）°, （16.8±11.4）°, P 〈 0.05]. ③ The situation of corrected vertebrae rotation： Compared with pre-operation, the rotation of vertebrae was reduced obviously 1 year after operation [（2.4±0.5）° , （1.8±0.6）° ,P 〈 0.05]. @The situation of height change： Compared with pre-operation, the body height was heightened apparently 1 year after the operation [（146±19.2）, （152±18.7）cm,P 〈 0.05]. ⑤The fusion of vertebrae： In 4 months after operation, all cases appeared fuzzily in the part of bone graft, and new bone was formed. In about 8 months after operation, a large amount of new bone was formed, which made the normal structure of the vertebra unable to show clearly. Internal fixation of all cases had no loosening and breakage All cases bad no late infection 3 weeks after operation and were not infected with the hepatitis or AIDS because of the use of the allogeneic bone. CONCLUSION： No obvious rejection reaction was found in the 18 cases during the experiment, and the incisions healed well, and the district of bone graft all obtained bone fusion. It is concluded that using China Great Wall System and freeze-dried allogeneic bone for treating scoliosis of the teenager has good stability.