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背景:脊柱侧凸矫正术中植骨融合技术是决定矫形治疗结果的关键因素之一。因自体骨应用受限,同种异体骨移植已广泛应用于临床。但同种异体皮质骨颗粒与同种异体松质骨颗粒在脊柱矫形患者中应用的实际效果是否一致?目的:比较不同种类骨移植在青少年特发性脊柱侧凸后路矫形植骨融合术中的应用效果。方法:2004年1月至2007年1月107例青少年特发性脊柱侧凸患者接受经后路脊柱侧凸矫形植骨融合手术。根据植骨材料不同分为A组(同种异体松质骨植骨,57例)和B组(同种异体皮质骨植骨,50例),比较两组患者随访第6、9、12、18、24、36个月的植骨融合情况、术后Cobb角变化情况及并发症等。结果:两组患者年龄、性别、主弯Cobb角、融合节段数及植骨量均无明显差异。平均随访时间为39.8个月。所有病例畸形明显矫正,术后1周总体矫正率为74.2%,最终随访总体矫正率72.1%。术后1周Cobb角及畸形矫形率,最终随访Cobb角、畸形矫形率及矫形度数丢失方面,两组相比均无明显统计学差异(P>0.05)。所有病例最终达到植骨骨性融合,A组平均融合时间15.0个月(6～36个月),B组平均融合时间15.9个月(6～36个月)。术后第6、9、12、18、24、36个月,两组骨性融合率均无明显统计学差异(P>0.05)。两组均未发生螺钉松动、断裂、断棒、假关节等并发症。术后A组4例(7.0%)、B组3例(6.0%)患者出现脑脊液漏,A组1例(1.8%)患者出现切口局部愈合障碍,均得到合理处理。结论:同种异体松质骨或皮质骨骨移植是脊柱侧凸后路矫形植骨融合术中较为理想的植骨方法之一,尤其是后者更是具有来源广泛、骨量大的优点。但在使用时,需根据同种异体骨骨愈合机制来制定术后治疗和康复计划,确保发挥复合骨移植在脊柱矫形术中的优势。
BACKGROUND: Orthopedic fusion in the treatment of scoliosis is one of the key determinants of orthopedic outcome. Due to the limited application of autologous bone, allograft bone transplantation has been widely used in clinical practice. However, the actual effect of allogeneic cortical bone granule and allograft cancellous bone granule in spine orthopedic patients are the same? Objective: To compare the effect of different types of bone graft in adolescent idiopathic scoliosis posterior bone graft fusion The application effect. METHODS: From January 2004 to January 2007, 107 adolescent idiopathic scoliosis patients underwent posterior scoliosis orthopedic fusion. According to the bone graft materials, group A was divided into group A (allograft cancellous bone graft, 57 cases) and group B (allograft cortical bone graft, 50 cases). The two groups were followed up for 6, 9, 18,24,36 months of bone fusion, changes in postoperative Cobb angle and complications. Results: There was no significant difference in age, sex, Cobb angle of main curve, fusion segments and bone mass between the two groups. The average follow-up time was 39.8 months. All cases of deformity were significantly corrected, the overall correction rate was 74.2% at 1 week after operation, the final follow-up overall correction rate was 72.1%. Cobb angle and deformity correction rate, Cobb angle, orthodontic rate and loss of orthopedic degree at 1 week postoperatively were not significantly different between the two groups (P> 0.05). All cases eventually achieved bone graft fusion. The average fusion time in group A was 15.0 months (range, 6 to 36 months), and the average fusion time in group B was 15.9 months (range, 6 to 36 months). At the 6th, 9th, 12th, 18th, 24th and 36th months after operation, there was no significant difference in bony fusion between the two groups (P> 0.05). No screw loosening, fracture, broken rod, false joint and other complications occurred in both groups. Cerebrospinal fluid leakage was found in 4 patients (7.0%) in group A and 3 patients (6.0%) in group B, and 1 patient (1.8%) in group A had partial incision healing. CONCLUSION: Allograft cancellous or cortical bone graft is one of the most ideal bone graft methods in orthopedic fusion of posterior scoliosis, especially the latter has the advantages of wide source and large bone mass. However, the use of allogeneic bone healing mechanisms to develop postoperative treatment and rehabilitation programs to ensure that the composite bone graft in the advantages of spinal surgery.