生物骨材料混合自体髂骨修复寰枢椎可复性脱位:后路固定植骨融合
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摘要
背景:研究表明,腰椎融合中生物骨材料植骨与自体髂骨移植相当,却明显降低了二次手术的风险,同时能更好地改善椎体功能障碍指数。目的:评价生物骨材料混合自体髂骨在寰枢椎可复性脱位后路钉棒内固定植骨融合中的效果。方法:选择可复性寰枢椎脱位患者72例,其中男37例,女35例,年龄28-72岁,均施行寰枢椎后路钉棒内固定植骨融合,寰椎采用侧块螺钉或椎弓根螺钉固定,枢椎采用椎弓根螺钉、椎板螺钉或侧块螺钉固定,分2组进行植骨融合:试验组(n=34)采用生物骨材料混合自体髂骨颗粒植骨融合,对照组(n=38)采用自体髂骨移植融合。治疗后随访12个月,对比两组植骨融合率、疼痛缓解、颈椎功能恢复、颈椎活动度及并发症发生情况。结果与结论:随访12个月,所有患者寰枢椎脱位复位内固定满意,颈部切口均I/甲愈合,均获得良好的骨性融合,融合率达100%;两组疼痛、颈椎功能、颈椎曲度和活动度均较治疗前明显改善(P<0.05),两组间植骨融合率、颈椎功能、颈椎曲度和活动度比较差异均无显著性意义;试验组取骨量、疼痛缓解时间少于对照组(P<0.05)。结果表明,采用生物骨材料混合自体髂骨进行可复性寰枢椎脱位后路钉棒内固定并植骨融合,可迅速缓解疼痛,减少取骨量,植骨融合率良好,颈椎功能恢复良好。
BACKGROUND: Studies have shown that biological bone and autogenous iliac bone exhibit equivalent lumbar fusion effects, but the former one significantly reduces the risk of secondary surgery and contributes to improving vertebral dysfunction. OBJECTIVE: To evaluate the effect of biological bone mixed with autologous bone in posterior screw rod internal fixation with bone graft fusion for reducible atlantoaxial dislocation. METHODS: Seventy-two patients with recoverable atlantoaxial dislocation, including 37 males and 35 females, aged 28-72 years old, were all subjected to posterior atlantoaxial screw rod fixation with bone graft fusion: the atlas was fixed with lateral mass screw or pedicle screw, and the axis fixed with the pedicle screw, lamina screws or lateral mass screw. These patients were assigned into experimental group(n=34) undergoing biological bone mixed with autologous iliac particle bone graft fusion, or control group(n=38) undergoing autologous iliac bone graft fusion. Twelve months later, fusion rate, pain relief, cervical function recovery, cervical activity and complications were compared between the two groups. RESULTS AND CONCLUSION: After postoperatively 12 months, all patients were satisfied with atlantoaxial dislocation reduction, with a good bone fusion rate up to 100%, and their neck incision healed well by primary intention. The pain, cervical function, cervical curvature and activity were improved significantly in the two groups after treatment(P < 0.05), but there was no significant difference between the two groups. Compared with the control group, the amount of bone mass taken from the patient and pain relief time were lower in the experimental group(P < 0.05). Taken together, the biological bone mixed with autogenous iliac bone for reducible atlantoaxial dislocation via posterior screw rod internal fixation and bone graft fusion can rapidly relieve pain, reduce the amount of bone mass taken from patients, and achieve good fusion effect and cervical functional recovery.
BACKGROUND: Studies have shown that biological bone and autogenous iliac bone exhibit equivalent lumbar fusion effects, but the former one significantly reduces the risk of secondary surgery and contributes to improving vertebral dysfunction. OBJECTIVE: To evaluate the effect of biological bone mixed with autologous bone in posterior screw rod internal fixation with bone graft fusion for reducible atlantoaxial dislocation. METHODS: Seventy-two patients with recoverable atlantoaxial dislocation, including 37 males and 35 females, aged 28-72 years old, were all subjected to posterior atlantoaxial screw rod fixation with bone graft fusion: the atlas was fixed with lateral mass screw or pedicle screw, and the axis fixed with the pedicle screw, lamina screws or lateral mass screw. These patients were assigned into experimental group(n=34) undergoing biological bone mixed with autologous iliac particle bone graft fusion, or control group(n=38) undergoing autologous iliac bone graft fusion. Twelve months later, fusion rate, pain relief, cervical function recovery, cervical activity and complications were compared between the two groups. RESULTS AND CONCLUSION: After postoperatively 12 months, all patients were satisfied with atlantoaxial dislocation reduction, with a good bone fusion rate up to 100%, and their neck incision healed well by primary intention. The pain, cervical function, cervical curvature and activity were improved significantly in the two groups after treatment(P < 0.05), but there was no significant difference between the two groups. Compared with the control group, the amount of bone mass taken from the patient and pain relief time were lower in the experimental group(P < 0.05). Taken together, the biological bone mixed with autogenous iliac bone for reducible atlantoaxial dislocation via posterior screw rod internal fixation and bone graft fusion can rapidly relieve pain, reduce the amount of bone mass taken from patients, and achieve good fusion effect and cervical functional recovery.
引文
[1]Harms J,Melcher RP.Posterior C1-C2 fusion with polyaxial screw and rod fixation.Spine.2001;26(22):2467-2471.
[2]马向阳,钟世镇,刘景发,等.寰枢椎后路椎弓根螺钉固定的生物力学评价[J].中国脊柱脊髓杂志,2003,13(12):735-738.
[3]Richter M,Schmidt R,Claes L,et al.Posterior atlantoaxial fixation:biomechanical in vitro comparison of six different techniques.Spine.2002;27(16):1724-1732.
[4]潘军伟,黄大耿,郝定均.寰枢椎失稳症的外科治疗研究进展[J].中国骨与关节损伤杂志,2014,29(3):308-309.
[5]Larcock PA,Cooper JJ.Adverse reactions of artificial bone graft substitutes:lessons learned from using tricalcium phosphate gene X.Clin Orthop Relat Res.2014;472(2):765-766.
[6]Ma XY,Yin QS,Wu ZH,et al.Anatomic considerations for the pedicle screw placement in the first cervical vertebra.Spine.2005;30(13):1519-1523.
[7]Yang SY,Boniello AJ,Poorman CE,et al.A review of the diagnosis and treatment of atlantoaxial dislocations.Global Spine J.2014;4(3):197-210.
[8]Behari S,Bhargava V,Nayak S,et al.Congenital reducible atlantoaxial dislocation:classification and surgical considerations.Acta Neurochir.2002;144(11):1165-1177.
[9]窦以宝,罗学勤,尹玉荣,等.寰枢椎椎弓根螺钉内固定治疗Ⅱ型齿突骨折合并寰枢椎脱位[J].脊柱外科杂志,2014,6(3):165-168.
[10]Yang JC,Ma XY,Xia H,et al.Clinical application of computer-aided design-rapid prototyping in C1-C2operation techniques for complex atlantoaxial instability.J Spinal Disord Tech.2014;27(4):E143-E150.
[11]王建华,尹庆水,夏虹,等.数字骨科技术在寰枢椎个体化置钉手术中的应用[J].脊柱外科杂志,2011,9(3):165-168.
[12]Jun SH,Lee EJ,Jang TS,et al.Bone morphogenic protein-2(BMP-2)loaded hybrid coating on porous hydroxyapatite scaffolds for bone tissue engineering.J Mater Sci Mater Med.2013;24(3):773-782.
[13]贾桂平,张建华,贾贵军.复杂颅颈交界区畸形合并寰枢椎脱位后路减压复位内固定术的护理配合[J].护理研究,2014,7(12):4429-4430.
[14]邓淼,权正学,罗小辑.寰枢椎椎弓根螺钉治疗寰枢椎不稳及脱位的临床效果[J].创伤外科杂志,2016,4(1):28-31.
[15]艾福志.寰枢椎脱位前路手术治疗-TARP内固定手术寰枢椎脱位系列讲座[J].中国骨科临床与基础研究杂志,2015,7(4):243-251.
[16]Brooks AL,Jenkins EB.Atlanto-axial arthrodesis by the wedge compression method.J Bone Joint Surg Am.1978;60(3):279-284.
[17]Magerl F,Seeman PS.Stable posterior fusion of the atlas and axis by transarticular screw fixation//Kehr P,Weidner A.Cervical Spine.New York:Spinger Verlag,1985:322-327.
[18]Goel A,Laheri V.Plate and screw fixation for atlanto-axial subluxation.Acta Neurochir.1994;129(1-2):47-53.
[19]Goel A,Desai KI,Muzumdar DP.Atlantoaxial fixation using palte and screw method:a report of 160 treated patients.Neurosurgery.2002;51(6):1351-1357.
[20]谭明生.寰枢椎脱位外科治疗的现状与思考[J].中华骨科杂志,2015,35(35):463-464.
[21]郭胜利,乔广宇,余新光,等.自发性寰枢椎脱位内固定技术的研究进展[J].中华神经外科杂志,2015,31(7):750-751.
[22]范军界,金正帅,殷国勇,等.寰枢椎椎弓根螺钉系统在寰枢椎骨折脱位中的应用[J].江苏医药,2015,41(9):1067-1069.
[23]Benke M,Yu WD,Peden SC,et al.Occipitocervical junction:imaging,pathology,instrumentation.Am J Orthop(Belle Mead NJ).2011;40(10):E205-215.
[24]刘斐文,张彤,孙川江,等.后路寰枢椎椎弓根螺钉短节段内固定治疗齿状突骨折并寰枢椎脱位[J].四川医学,2014,35(2):221-223.
[25]丁英胜,张文志,段丽群,等.后路寰枢椎椎弓根固定融合治疗寰枢椎不稳或脱位[J].临床骨科杂志,2015,18(1):1-4.
[26]王明飞,纪斌,王健,等.寰枢椎后路线缆内固定融合术治疗寰枢椎不稳的长期疗效分析[J].中国矫形外科杂志,2015,23(11):972-975.
[27]马向阳,杨进城,邱锋,等.寰枢椎脱位后路植骨材料的选择与融合效果评价[J].中国骨科临床与基础研究杂志,2015,7(1):5-9.
[28]Chen Z,Ba G,Shen T,et al.Recombinant human bone morphogenetic protein-2 versus autogenous iliac crest bone graft for lumbar fusion:a meta-analysis of ten randomized controlled trials.Arch Orthop Trauma Surg.2012;132(12):1725-1740.
[29]张志宏,刘志礼,高志增,等.骨修复材料修复骨缺损的选择与应用[J].中国组织工程研究,2012,16(52):9836-9843.
[30]梁必如,严坚强,孙奎,等.颅骨牵引联合短节段枕颈固定颗粒状植骨融合治疗寰枕融合畸形并寰枢椎脱位[J].中国骨与关节损伤杂志,2014,29(5):472-473.
[2]马向阳,钟世镇,刘景发,等.寰枢椎后路椎弓根螺钉固定的生物力学评价[J].中国脊柱脊髓杂志,2003,13(12):735-738.
[3]Richter M,Schmidt R,Claes L,et al.Posterior atlantoaxial fixation:biomechanical in vitro comparison of six different techniques.Spine.2002;27(16):1724-1732.
[4]潘军伟,黄大耿,郝定均.寰枢椎失稳症的外科治疗研究进展[J].中国骨与关节损伤杂志,2014,29(3):308-309.
[5]Larcock PA,Cooper JJ.Adverse reactions of artificial bone graft substitutes:lessons learned from using tricalcium phosphate gene X.Clin Orthop Relat Res.2014;472(2):765-766.
[6]Ma XY,Yin QS,Wu ZH,et al.Anatomic considerations for the pedicle screw placement in the first cervical vertebra.Spine.2005;30(13):1519-1523.
[7]Yang SY,Boniello AJ,Poorman CE,et al.A review of the diagnosis and treatment of atlantoaxial dislocations.Global Spine J.2014;4(3):197-210.
[8]Behari S,Bhargava V,Nayak S,et al.Congenital reducible atlantoaxial dislocation:classification and surgical considerations.Acta Neurochir.2002;144(11):1165-1177.
[9]窦以宝,罗学勤,尹玉荣,等.寰枢椎椎弓根螺钉内固定治疗Ⅱ型齿突骨折合并寰枢椎脱位[J].脊柱外科杂志,2014,6(3):165-168.
[10]Yang JC,Ma XY,Xia H,et al.Clinical application of computer-aided design-rapid prototyping in C1-C2operation techniques for complex atlantoaxial instability.J Spinal Disord Tech.2014;27(4):E143-E150.
[11]王建华,尹庆水,夏虹,等.数字骨科技术在寰枢椎个体化置钉手术中的应用[J].脊柱外科杂志,2011,9(3):165-168.
[12]Jun SH,Lee EJ,Jang TS,et al.Bone morphogenic protein-2(BMP-2)loaded hybrid coating on porous hydroxyapatite scaffolds for bone tissue engineering.J Mater Sci Mater Med.2013;24(3):773-782.
[13]贾桂平,张建华,贾贵军.复杂颅颈交界区畸形合并寰枢椎脱位后路减压复位内固定术的护理配合[J].护理研究,2014,7(12):4429-4430.
[14]邓淼,权正学,罗小辑.寰枢椎椎弓根螺钉治疗寰枢椎不稳及脱位的临床效果[J].创伤外科杂志,2016,4(1):28-31.
[15]艾福志.寰枢椎脱位前路手术治疗-TARP内固定手术寰枢椎脱位系列讲座[J].中国骨科临床与基础研究杂志,2015,7(4):243-251.
[16]Brooks AL,Jenkins EB.Atlanto-axial arthrodesis by the wedge compression method.J Bone Joint Surg Am.1978;60(3):279-284.
[17]Magerl F,Seeman PS.Stable posterior fusion of the atlas and axis by transarticular screw fixation//Kehr P,Weidner A.Cervical Spine.New York:Spinger Verlag,1985:322-327.
[18]Goel A,Laheri V.Plate and screw fixation for atlanto-axial subluxation.Acta Neurochir.1994;129(1-2):47-53.
[19]Goel A,Desai KI,Muzumdar DP.Atlantoaxial fixation using palte and screw method:a report of 160 treated patients.Neurosurgery.2002;51(6):1351-1357.
[20]谭明生.寰枢椎脱位外科治疗的现状与思考[J].中华骨科杂志,2015,35(35):463-464.
[21]郭胜利,乔广宇,余新光,等.自发性寰枢椎脱位内固定技术的研究进展[J].中华神经外科杂志,2015,31(7):750-751.
[22]范军界,金正帅,殷国勇,等.寰枢椎椎弓根螺钉系统在寰枢椎骨折脱位中的应用[J].江苏医药,2015,41(9):1067-1069.
[23]Benke M,Yu WD,Peden SC,et al.Occipitocervical junction:imaging,pathology,instrumentation.Am J Orthop(Belle Mead NJ).2011;40(10):E205-215.
[24]刘斐文,张彤,孙川江,等.后路寰枢椎椎弓根螺钉短节段内固定治疗齿状突骨折并寰枢椎脱位[J].四川医学,2014,35(2):221-223.
[25]丁英胜,张文志,段丽群,等.后路寰枢椎椎弓根固定融合治疗寰枢椎不稳或脱位[J].临床骨科杂志,2015,18(1):1-4.
[26]王明飞,纪斌,王健,等.寰枢椎后路线缆内固定融合术治疗寰枢椎不稳的长期疗效分析[J].中国矫形外科杂志,2015,23(11):972-975.
[27]马向阳,杨进城,邱锋,等.寰枢椎脱位后路植骨材料的选择与融合效果评价[J].中国骨科临床与基础研究杂志,2015,7(1):5-9.
[28]Chen Z,Ba G,Shen T,et al.Recombinant human bone morphogenetic protein-2 versus autogenous iliac crest bone graft for lumbar fusion:a meta-analysis of ten randomized controlled trials.Arch Orthop Trauma Surg.2012;132(12):1725-1740.
[29]张志宏,刘志礼,高志增,等.骨修复材料修复骨缺损的选择与应用[J].中国组织工程研究,2012,16(52):9836-9843.
[30]梁必如,严坚强,孙奎,等.颅骨牵引联合短节段枕颈固定颗粒状植骨融合治疗寰枕融合畸形并寰枢椎脱位[J].中国骨与关节损伤杂志,2014,29(5):472-473.