环锯切除骨原位直立移植在颈椎前路减压融合术中的应用  

Autogenous bone graft harvested from trephination for arthrodesis of one single cervical intervertebral space following decompression

作　　者：赵虬[1] 王沛[1] 邰杰[1] 马信龙[1] 

机构地区：[1]天津医科大学总医院骨科,300052

出　　处：《中华骨科杂志》2000年第11期656-658,共3页Chinese Journal of Orthopaedics

摘　　要：目的 探讨环锯减压切除骨可否替代髂骨进行颈椎前路单一节段减压融合术中的自体骨移植融合操作。方法 回顾性分析了 30例单一节段受累的脊髓型颈椎病病例，采用经颈椎前路环锯减压、骨原位直立移植融合术，治疗脊髓型颈椎病并观察其临床效果。平均随访 4.75年，按 JOA评分及 Hirabayashi等恢复率评定手术效果，颈椎正、侧位及屈、伸侧位 X线检查判定融合效果。结果 随访时，手术效果优 15例 (50％ )、良 11例 (36.7％ )、可 3例 (10％ )、差 1例 (3.3％ )，优良率达 86.7％。经 X线检查证实融合率为 100％，植骨块无移位、脱落，颈椎曲度仅有部分丧失。结论 颈椎前路环锯减压切除骨可替代其他方式的自体骨进行移植融合术。此术式操作简便，融合率高，术后颈椎曲度虽有部分丧失，但不影响手术效果，随访时手术效果无减退。Objective To investigate whether the bone harvested from Cloward discectomy with trephine could substitute for iliac-crest bone grafts in arthrodesis procedure. Methods We reviewed the 30 patients with cervical spondylotic myelopathy involving a single level, which had been managed with anterior trephination discectomy and arthrodesis by the bone chips harvested from within the trephine. The bone chips harvested with trephine were then trimed and implanted erectedly similar to Robinson arthrodesis procedure. All cases had been followed-up for an average of 4.75 years. The latest results were analyzed according to JOA score system and recovery rate. The fusion outcome were assessed by anteroposterior and flexion and extension lateral radiographs of the cervical spine. Results At the latest followed-up examination, clinical results were excellent in fifteen patients(50％ ), good in eleven(36.7％ ), fair in three(10％ ) and poor in one (3.3％ ). X-ray showed solid fusion in all, and no dislodgment of the grafts. However, the cervical curves had a little loss. There was no significant bone grafts subsidence. Conclusion In cervical anterior decompression the bone chips obtained in trephination could substitute for other type of bone grafts for arthrodesis. The postoperative outcomes were not affected by the loss of the cervical curves.

关 键 词：颈椎前路减压融合术 环锯切除骨 原位直立移植 

分 类 号：R687.3[医药卫生—骨科学]