胸骨柄松质骨结合钛网支撑满足颈椎前路修复植骨需求的可行性(英文)  

Feasibility of manubrium sterni cancellous bone plus pyramesh in anterior cervical spinal fusion surgery

作　　者：王高举[1] 王清[1] 王松[1] 钟德君[1] 王专[1] 文睿[1] 

机构地区：[1]泸州医学院附属医院脊柱外科,四川省泸州市646000

出　　处：《中国组织工程研究与临床康复》2011年第9期1698-1701,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:现今临床上常用的自体植骨材料多为髂骨、胫骨、腓骨等部位的松质骨块或骨碎块。采用胸骨柄松质骨作为植骨材料融合稳定颈椎未见报道。目的:测量国人胸骨柄标本及无明显退变的颈椎X射线侧位片,探讨胸骨柄内松质骨结合钛网植骨在颈椎前路手术中应用的可行性,为自体骨移植开发一个新的植骨材料来源。方法:测量40具胸骨柄标本的胸骨柄长、胸骨柄最大宽、胸骨柄最小宽、胸骨柄厚、胸骨柄前皮质厚及胸骨柄后皮质厚,计算胸骨柄体积。将胸骨柄长、胸骨柄最大宽、最小宽每边减去4mm,胸骨柄前、后皮质骨减去1mm作为胸骨柄内松质骨取骨区(以下简称供区)边界,计算胸骨柄内供区的体积。选择106例无明显退变的中立位颈椎侧位X射线片,测量C2～3至C7～T1椎间隙和C3～C7椎体高度。计算常规颈椎前路术中单间隙、双间隙、三间隙椎间盘切除,1个椎体+2个椎间盘及2个椎体+3个椎间盘切除所需钛网长度和钛网内所需植骨体积。验证供区内松质骨是否满足临床需要。结果与结论:胸骨柄体积为(17735.51±5231.93)mm3;供区松质骨体积为(8982.83±2437.56)mm3。颈前路术中使用钛网最短和所需植骨量最小为单间隙植骨,所需钛网最长和所需植骨量最大为2个椎体+3个椎间隙切除。颈椎前路常用的任意一种术式中,钛网内所需盛骨体积均明显小于供区体积。提示胸骨柄内松质骨结合钛网支撑可满足大多数颈椎前路融合过程中的植骨需求。与自体髂骨植骨相比,操作更简单方便,不影响患者早期功能锻炼和负重行走。BACKGROUND：Current commonly used bone graft materials include cancellous bone or bone blocks from ilium,tibia,fibula and others.There is no report of bone graft and fusion in cervical spine from manubrium sterni.OBJECTIVE：To measure lateral X-ray of cervical vertebrae with no degeneration and manubrium sterni samples to explore feasibility of autologous cancellous bone graft of manubrium sterni with pyramesh in anterior cervical spinal fusion surgery,so as to develop a new source of autogenous bone graft.METHODS：A total of 40 manubrium sterni specimens were selected and the length,maximum width andminimum width,thickness,anterior and posterior cortex thickness of manubrium sterni were measured.Manubrium sterni area was calculated：the length,maximum width andminimum width were 4 mm reduced from those of manubrium sterni,its thickness was 2 mm reduced from that of manubrium sterni.The formula of measuring the manubrium sterni volume is （maximum width of manubrium sterni＋ theminimum width of manubrium sterni）×length of manubrium sterni×thickness of manubrium sterni×1/2.Intervertebral height and vertebral height from C2 to C7 were measured from lateral cervical radiograph of 106 patients with cervical radiolopathy,and the length of pyramesh needed in anterior cervical spinal surgery for one,two,three discs resection,one vertebra plus two discs resection and two vertebrae plus three discs resection was calculated.RESULTS AND CONCLUSION：The manubrium sterni volume was （17 735.51±5 234.92） mm3 and the volume of bone-grafting area was （8 982.83±2 427.76） mm3.The length of pyramesh and volume of bone used in operation wereminimal for one disc resection,and maximal for two vertebrae plus three discs resection.The volume of bone graft in the pyramesh was significantly less than the donor area in any anterior cervical spinal fusion operation.Results show that autologous cancellous graft of manubrium sterni combined with pyramesh supporting can be used in anterior cervical spinal fusion surgery.Co

关 键 词：胸骨柄 钛网支撑 解剖学测量 颈椎 植骨 

分 类 号：R318[医药卫生—生物医学工程]