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首页> 外文期刊>Spine >Comparison of bone grafts for posterior spinal fusion in adolescent idiopathic scoliosis.
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Comparison of bone grafts for posterior spinal fusion in adolescent idiopathic scoliosis.

机译：青少年特发性脊柱侧弯后路植骨的植骨比较。

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摘要

STUDY DESIGN: A retrospective comparison of three different types of bone grafts for posterior spinal fusion in adolescent idiopathic scoliosis. OBJECTIVE: To determine the efficacy of bone marrow and demineralized bone matrix as a bone graft substitute for spinal fusion. SUMMARY OF BACKGROUND DATA: Several reports have documented a high morbidity associated with harvesting autologous iliac crest bone graft (ICBG) for spinal fusion. Composite bone graft consisting of demineralized bone matrix and aspirated bone marrow may reduce the morbidity and still retain the osteoinductive properties of iliac crest autograft. METHODS: Three different bone grafting techniques were used by a single surgeon in 88 consecutive patients who had posterior spinal fusion for adolescent idiopathic scoliosis. Segmental instrumentation with dual-rod fixation was used in all cases. Selection of type of graft was determined historically by the time when the operations were performed. Autologous ICBG was used in Group A, freeze-dried corticocancellous allograft in Group B, and composite graft of autologous bone marrow and demineralized bone matrix in Group C. Seventy-seven patients were reviewed, with a minimum of 2 years' follow-up (mean, 3 years 7 months; range, 2 years-9 years 5 months). Radiographs were assessed for pseudarthrosis and loss of correction of 10 degrees or more. Loss of 10 degrees of correction has been previously identified as an indicator of potential pseudarthrosis or fusion instability. Both of these criteria were used to compare success of fusion. RESULTS: Failure caused by pseudarthroses was seen in two patients (2.6%), one in Group A and one in Group B. Eleven patients lost greater than 10 degrees of correction, but only one demonstrated pseudarthroses. The 13 patients with pseudarthroses or loss of correction constitute the failure group for purposes of graft assessment. The failure rate was 12.5% in Group A (ICBG), 28% in Group B (freeze-dried corticocancellous allograft), and 11.1% in Group C (composite graft of autologous bone marrow and demineralized bone matrix). Eliminating patients with crankshaft phenomenon did not substantially change the results. There was no morbidity associated with bone marrow aspiration. CONCLUSIONS: Fusion rates were comparable for GroupA (ICBG) and Group C (composite graft of autologous bone marrow and demineralized bone matrix). The composite graft is our preferred graft for fusions in adolescent idiopathic scoliosis.
机译：研究设计：回顾性比较三种不同类型的骨移植，用于青少年特发性脊柱侧弯后路融合术。目的：确定骨髓和软化骨基质作为脊柱融合的骨移植替代物的功效。背景技术摘要：几份报告记录了与自体骨骨移植物（ICBG）收获以进行脊柱融合相关的高发病率。由去矿质骨基质和抽吸骨髓组成的复合骨移植物可以降低发病率，并且仍保留auto自体移植物的骨诱导特性。方法：单位外科医生对88例因青少年特发性脊柱侧凸进行后路脊柱融合术的连续患者采用了三种不同的植骨技术。在所有情况下均使用带双杆固定的节段器械。移植物类型的选择历史上是在进行手术时确定的。 A组采用自体ICBG，B组采用冻干同种异体骨移植，C组采用自体骨髓和去矿质骨基质的复合移植。对77例患者进行了回顾，至少随访2年（平均3年7个月;范围2年9年5个月）。评估X线片是否有假关节和10度以上的矫正损失。先前已经确定丧失10度矫正是潜在的假关节或融合不稳定的指标。这两个标准都用于比较融合成功与否。结果：2名患者（2.6％）观察到假藻引起的衰竭，A组中一名，B组中一名。11位患者的矫正度超过10度，但只有1名表现出假藻酸盐。为了移植评估的目的，13例假性角膜塑形或矫正丧失患者组成了衰竭组。 A组（ICBG）的失败率是12.5％，B组（冻干的皮质突状同种异体移植）的失败率是28％，C组（自体骨髓和去矿质骨基质的复合移植）的失败率是11.1％。消除有曲轴现象的患者并没有实质改变结果。没有与骨髓抽吸相关的发病率。结论：A组（ICBG）和C组（自体骨髓和去矿质骨基质的复合移植物）的融合率相当。复合移植物是我们在青少年特发性脊柱侧弯融合的首选移植物。

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