胸骨柄松质骨结合钛网植骨在颈椎前路手术中的应用研究

Application of autologous cancellous graft of sternal manubrium with pyramesh in anterior cervical spinal fusion surgery

目的 探讨胸骨柄内松质骨结合钛网植骨在颈椎前路手术中的应用。方法4 0具胸骨柄标本将胸骨柄长度、最大宽度、最小宽度每边减去4mm，胸骨柄前、后皮质骨减去1mm作为胸骨柄内松质骨取骨区（以下简称供区）边界，计算胸骨柄内供区的体积。106例颈椎侧位X线片：测量C2～3至C7～T1椎间隙和C3～C7椎体高度。计算颈椎前路常用术式中椎间融合支撑所需钛网高度和钛网内所需植骨体积。对颈前路术中需行髂骨植骨的患者37例，术中刮取胸骨柄内松质骨填充钛网行支撑固定，随访该组患者的临床疗效。结果 胸骨柄供区松质骨体积（8982．83±2437．56）mm^3。颈椎前路术中单间隙、双间隙、三间隙椎间盘切除，1个椎体＋2个椎间盘和2个椎体＋3个椎间盘切除后，行椎间融合支撑所需钛网高度分别为5．27～6．38mm、10．38～11．35mm、16．64～18．45mm、24．36—29．26mm和35．06～39．75mm；相应钛网内所需植骨体积分别为413．70～500．83mm^3、893．33—969．50mm^3、1306．24～1448．33mm^3、1833．76～2061．41mm^3和3223．22～3434．38mm^3。37例患者均顺利完成手术，取骨区切口无感染血肿形成，无血管神经损伤。随访3个月-4年，平均2．2年，所有患者颈椎已完全骨性融合，无假关节形成，无钢板螺钉松动断裂和钛网移位，胸骨柄无塌陷，外形完整，无胸骨柄和双侧胸锁关节疼痛。胸骨柄切口周围色素沉着3例。结果 胸骨柄内松质骨结合钛网支撑可满足大多数颈椎前路融合术中的植骨需求。与自体髂骨植骨相比，操作更简单方便，不影响患者早期功能锻炼和负重行走。

Objective To explore application of autologous cancellous graft of sternal manubrium （MS） with pyramesh in anterior cervical spinal fusion. Methods A total of 40 dry MS specimens were used. Border of harvesting cancellous bone area （donor site） was decided by cutting 4 mm of MS length, maximum width and minimum width and by cutting 1 mm from anterior and posterior os integumentale. MS volume and donor volume were calculated. Intervertebral space of C2-3-C7-T1 and vertebral height of C3-C7 were measured from lateral cervical radiograph of 106 cases. The length of pyramesh needed in anterior cervical spinal surgery was calculated according to different type of anterior procedures. Thirty-seven cases treated by autologous cancellous graft of MS with pyramesh were fixated with titanium net by scraping cancellated bone from sternal rnanubrium and clinical results observed. Result The volume of donor sits was （ 8 982.83 ±2 437.56） mm^3. The length of pyramesh used in operation for one, two, three discectomy was 5.27-6.38 mm, 10.38-11.35 mm, 16.64-18.45 mm respectively and 24.36-29.26 mm for one vertebra plus two discectomy, 35.06-39.75 mm for two vertebrae plus three discectomy. Corresponding cancellous volume in pyramesh in above methods of intervertebral fusion was 413.70 - 500. 83 mm^3, 893.33 969.50 mm^3 ,1 306.24 - 1 448.33 mm^3 , 1 833.76 - 2 061.41 mm^3 and 3 223.22 - 3 434.38 mm^3 respectively. Operations of 37 cases were completed successfully, with no incision infection hematoma or injuries of important structures in donor sits. All cases were followed up for average 2.2 years （ ranging from 3 months to 4 yea~）. Successful fusion of cervical spine was obtained in 37 cases, with no pseudarthrosis of cervical vertebra. Also, there was no loosening or brakeage of plate or dislocation of pyramesh. There were no sinking or pain of MS and sternoclavicalar joint in all cases, pigmentation around incision had emerged in 3 cases. Conclusion Autologous cancellous graft of MS is a new source of bone graft in anterior cervical spinal fusion surgery with Pyramesh supporting. It is more convenient than autologous illic graft and can not affect early functional exercise.