胸腰椎前路手术髂嵴供骨区重建的临床应用

CLINICAL APPLICATION OF RIB AUTOGRAFT FOR ILIAC CREST RECONSTRUCTION BY ANTERIOR APPROACH OF THORACIC AND LUMBAR VERTEBRAE

目的探讨胸腰椎前路手术采用自体肋骨段移植行髂嵴供骨区重建的临床应用及疗效分析。方法2004年9月-2007年9月,对符合纳入标准的54例胸腰段脊柱损伤患者行胸腰椎前路手术取髂骨行椎体间植骨,其中25例髂嵴供骨区取自体肋骨重建(重建组),余29例供骨区用骨蜡封闭止血(非重建组)。其中男39例,女15例;年龄27～59岁,平均42岁。脊柱结核4例,胸腰椎爆裂骨折50例。两组性别构成、年龄、体重比较差异无统计学意义(P>0.05)。分别于术后2周和3、12个月采用疼痛视觉模拟评分(visual analogue score,VAS)评估手术部位的疼痛程度;术后12个月评价患者对髂嵴外观满意度及系腰带活动时的舒适度;观察患者术后1年内在非意外创伤前提下是否发生髂前上棘撕脱骨折,通过X线片观察重建组髂嵴愈合情况及是否发生骨折。结果术后两组患者伤口均Ⅰ期愈合,无早期相关并发症发生。两组均获随访,随访时间1年。术后2周和3个月平卧位术侧髋关节静止时两组VAS比较差异无统计学意义(P>0.05);术后2周和3个月术侧髋关节活动时及术后1年术侧卧位时,两组VAS比较差异均有统计学意义(P<0.05),重建组低于非重建组。术侧髂嵴外观满意度、系腰带活动时舒适度两组比较差异均有统计学意义(P<0.05),重建组的满意度及舒适度均高于非重建组。术后1年内两组均未发生髂前上棘撕脱骨折,重建组未发生重建的髂嵴骨折,X线片示髂嵴处肋骨两端影像模糊,肋骨与髂嵴愈合良好。结论胸腰椎前路手术采用自体肋骨段移植行髂嵴供骨区重建,取材简便,能较好地改善局部外观,明显减轻局部疼痛,提高患者术后生活质量。

Objective To explore the clinical application of rib autograft for reconstructing lilac crest by anterior approach of thoracic and lumbar vertebrae, and to observe the short-term and long-term effects. Methods From September 2004 to September 2007, 54 cases of thoracic and lumbar injuries were treated by the surgery of anterior approach of thoracic and lumbar vertebrae.There were 39 males and 15 females with an average age of 42 years old （range, 27-59 years old）, including 4 cases of tuberculosis of spine and 50 cases of thoracic and lumbar vertebrae bursting fracture. All cases underwent the surgery of anterior approach of thoracic or lumbar and iliac crest was used as autograft. Fifty-four patients were randomized into the reconstruction group （RG, n=25） and the non-reconstruction group （NRG, n=29）. The patients of RG group were treated with rib autograft for reconstructing iliac crest. There were no statistically significant differences in general data between two groups （P 〉 0.05）. The visual analogue scores （VAS） was used to estimate pain degree of treated hip after 2 weeks, and 3, 12 months. The extenion satisfaction grade of iliac crest and the comfort degree of action while bundling waist belt were estimated after 12 months. It was observed whether or not anterior superior iliac spine avulsion fracture occurred on the premise of non-accidental trauma within 1 year. The occurrence of fracture and the union status of reconstructed iliac crest were observed by X-ray after 1 year. Results All wounds achieved primary healing. No complication was found at early stage. All patients were followed up I year. There was no significant difference in the VAS of the treated hi p under conditions of clinostatism rest between two groups after 2 weeks and 3 months （P 〉 0.05）. But there was significant difference in the VAS under conditions of action after 2 weeks and 3 months, under conditions of dinostatism rest after 12 months （P 〈 0.05）, and the VAS of RG was lower than that of NRG. The exterior satisfaction grade of lilac crest and comfort degree of action while bundling waist belt in RG were higher than those in NRG after 1 year, showing significant differences （P 〈 0.05）. No anterior superior iliac spine avulsion fracture occurred after 1 year. And in RG group no fracture of reconstructed iliac crest occurred after 1 year. The X-ray film showed that the two ends of rib reconstructed by iliac crest were blur, and that the rib healed well with iliac bone. Conclusion Rib autograft for reconstruction of iliac crest by anterior approach of thoracic and lumbar vertebrae was economic and convenient. It could improve local appearance, reduce the local pain, and improve patients＇ life quality.