同种异体骨与自体骨混合移植在脊柱融合中的应用  

APPLICATION OF SMALL FREEZE-DRYING ALLOGENEIC BONE PLOTS MIXED WITH AUTOLOGOUS BONE GRAFT IN SPINAL FUSION

作　　者：田长庆[1] 李振宇[1] 周文钰[1] 曾腾辉[1] 孙世荃[2] 李宝兴[2] 

机构地区：[1]深圳市第二人民医院脊柱外科,广东深圳518035 [2]山西省医用组织库

出　　处：《中国修复重建外科杂志》2009年第5期517-519,共3页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：深圳市科技基金资助项目(20040502)~~

摘　　要：目的探讨同种异体骨与自体骨混合移植在脊柱融合中的成骨效果、并发症及影响因素,并与单纯自体骨移植进行比较。方法2003年1月-2007年1月,收治脊柱损伤患者515例,其中采用同种异体骨与自体骨混合移植(A组)324例,男211例,女113例;年龄18～83岁,平均36岁。胸腰椎骨折182例,腰椎滑脱68例,腰椎管狭窄症47例,颈椎间盘突出症17例,颈椎骨折脱位5例,胸腰椎肿瘤5例。术中植骨量10～60g,平均30g。采用单纯自体骨移植组(B组)191例,男135例,女56例;年龄23～78岁,平均32岁。胸腰椎骨折109例,腰椎滑脱23例,腰椎管狭窄症17例,颈椎间盘突出症19例,颈椎骨折脱位23例。术中植骨量10～50g,平均25g。结果A组4例伤口于术后3d渗液增加,渗液细菌培养为阴性,予局部冲洗、充分引流、应用皮质激素后2周内渗液均吸收;B组术后无大量渗液。两组术后均获随访,随访时间A组10～36个月,平均17.4个月;B组8～36个月,平均16.8个月。影像学检查示A组308例(95.06%)于术后4～10个月,平均8.1个月达骨性愈合;脊柱融合失败16例(4.94%)。B组184例(96.34%)于术后4～10个月,平均5.8个月达骨性愈合;脊柱融合失败7例(3.66%)。两组骨融合率比较差异无统计学意义(P>0.05)。两组均无深部感染或窦道形成。根据Mankin等及Komender等评分标准,A组满意308例(95.06%),不满意16例(4.94%);B组满意184例(96.34%),不满意7例(3.66%);两组间比较差异无统计学意义(P>0.05)。结论同种异体骨与自体骨混合移植在脊柱骨性融合方面与单纯自体骨移植效果相同,可弥补自体骨量不足的缺陷。Objective To investigate the osteoblasts e ect, complications and in uencing factors in the application of small freeze-drying allogeneic bone plots mixed autologous bone fragments in spinal surgery, and to compare with autogenous bone graft.Methods From January 2003 to January 2007, 515 cases of spinal injuries were treated.A total of 324 cases were treated with small freeze-drying allogeneic bone plots mixed with autologous bone grafts（group A）, including 211 males and 113 females with an average age of 36 years（18-83 years）.There were 182 cases of thoracolumbar vertebra fracture, 68 cases of lumbar spondylolisthesis, 47 cases of lumbar vertebral canal stenosis, 17 cases of cervical disc herniation, 5 cases of cervical spine fracture-dislocation and 5 cases of thoracolumbar vertebra tumor.The weight of bone graft was 10-60 g（mean 30 g）.A total of 191 cases were treated with autogenous bone grafting（group B）, including 135 males and 56 females with an average age of 32 years（23-78 years）.There were 109 cases of thoracolumbar vertebra fracture, 23 cases of lumbar spondylolisthesis, 17 cases of lumbar vertebral canal stenosis, 19 cases of cervical disc herniation, and 23 cases of cervical spine fracture-dislocation.The weight of bone graft was 10-50 g（mean 25 g）.Results In group A, e usion of wound increased in 4 cases and the result of bacterial culture was negative;e usion was absorbed after 2 weeks of local irrigation, drainege and cortin management.In group B, no obvious e usion was observed.The follow-up time was 10-36 months（mean 17.4 months） in group A and 8-36 months（mean 16.8 months） in group B.The bone healing was achieved in 308 cases within 4-10 months（mean 8.1 months） and in 184 cases within 4-10 months（mean 5.8 months）, and the bone fusion rates were 95.06% and 96.34% in groups A and B, respectively.There was no signi cant di erence in bone fusion rate between groups（P 〉 0.05）.According to Mankin and Komender evaluation standard, the response rates were 9

关 键 词：自体骨移植 同种异体骨移植 脊柱融合 

分 类 号：R687.34[医药卫生—骨科学] R681.5[医药卫生—外科学]