异体腓骨移植在脊髓型颈椎病治疗中的应用

Allograft fibula in treatment of cervical spondylosis

目的 探讨冻干异体腓骨移植替代髂骨进行颈椎前路减压融合治疗颈椎病的可行性。方法 回顾性分析了 38例采用经颈椎前路减压冻干异体腓骨移植融合结合前路钛钢板固定治疗颈椎病的临床效果。平均随访 (9 5± 3 4 )个月 ,按JOA评分及Nurick分级评定手术效果 ,颈椎正、侧位及屈、伸侧位X线检查判定融合效果。 结果 JOA评分从术前的 (12 5 4± 1 6 2 )分提高到 (16 0 7±1 13)分 (P <0 0 5 ) ;Nurick分级从术前的 (2 4 6± 0 4 3)级提高到术后的 (0 72± 0 37)级 (P <0 0 5 )。经X线检查证实椎间隙高度得到恢复、颈椎生理前凸部分恢复、植骨块无移位、脱落、塌陷 ,钛钢板及螺丝钉无移位及松脱。 5个月后植骨全部融合。 结论 在颈椎病前路手术中冻干异体腓骨移植融合结合前路钛钢板固定术可替代自体骨移植融合术。此手术方法短期效果可靠 ,减少了取髂骨的并发症 。

Objective To evaluate the efficacy of allograft fibula in anterior cervical fusion for cervical spondylosis patients treated by Smith Robinson operation supplemented with anterior instrumentation. Methods The clinical outcome of 38 patients with cervical spondylosis treated by Smith Robinson operation using allograft fibula supplemented with anterior titanium plate were retrospectively studied. The patients were followed up on average was (9 5±3 4) months. The average preoperative and postoperative JOA scores were assessed and myelopathy severity was graded using the Nurick myelopathy grading system. Lateral views in neutral position, in flexion, and in extension of preoperative cervical roentgenograms were analyzed in comparison with last follow up films to identify the changes in the height of intervertebral space and the quality of fusion. Results Statistical analysis of all patients revealed mean JOA scores of 12 54±1 62 and 16 07±1 13 before surgery and at final examination( P <0 05), respectively. And the mean Nurick grades were 2 46±0 43 and 0 72±0 37 before and after surgery( P <0 05), respectively. Radiographic follow up revealed that the height intervertebral space and the lordosis of the cervical spine had been restored and no allograft was found displaced or collapsed and also revealed that all grafts obtained union by 5 months after surgery. Conclusions Fibular allograft can replace autologous iliac crest graft in the treatment of cervical spondylosis patients. This method is safe and efficacious and can avoid bone graft site morbidity.