Wilden Jessica A, Moran Steven L, Dekutoski Mark B, Bishop Allen T, Shin Alexander Y
Mayo Clinic, Rochester, Minnesota 55905, USA.
J Bone Joint Surg Am. 2006 Apr;88(4):832-9. doi: 10.2106/JBJS.E.00409.
The application of vascularized rib grafts in spine surgery has been limited to the treatment of kyphosis with anterior placement of the rib graft to facilitate anterior spine arthrodesis. The outcomes following use of vascularized rib grafts in complex spinal reconstruction have not been adequately evaluated. The purpose of this study was to determine the results, including the time to osseous union and complications, following anterior or posterior placement of pedicled vascularized rib grafts for complex spinal reconstruction.
The medical records and images of all patients in whom a vascularized rib graft had been used for a multisegmental spine reconstruction at a single institution between 1994 and 2004 were retrospectively reviewed. Eighteen patients (mean age, 45.3 years) who had been followed for an average of 31.8 months were identified. Details regarding indications, the levels that were spanned, the graft length, the time to union, and complications were evaluated.
The preoperative diagnoses included metastatic or primary tumor (thirteen patients) and progressive kyphosis secondary to chronic osteomyelitis (two), injury (one), congenital anomalies (one), or implant failure (one). On the average, 4.4 levels were fused and 1.9 vertebral bodies were excised. All eighteen arthrodeses included various forms of allograft and/or autograft material, and instrumentation was used, in addition to the vascularized rib graft, in twelve patients. The mean rib length was 16.1 cm, and a rib between the fifth and eleventh ribs, inclusive, was used, depending on the location of the spinal reconstruction. The average time to union was 6.8 months, and all rib grafts united. There were no complications specific to the rib-harvesting procedure.
The use of a vascularized rib graft in complex spinal reconstruction adds little time to the overall procedure, is associated with low morbidity, and appears to offer substantial benefits to the patient.
带血管蒂肋骨移植在脊柱手术中的应用一直局限于通过肋骨移植前路放置治疗后凸畸形，以促进前路脊柱融合。带血管蒂肋骨移植在复杂脊柱重建中的应用效果尚未得到充分评估。本研究的目的是确定在复杂脊柱重建中，带血管蒂肋骨移植前路或后路放置后的结果，包括骨愈合时间和并发症。
回顾性分析1994年至2004年在单一机构接受带血管蒂肋骨移植进行多节段脊柱重建的所有患者的病历和影像资料。确定了18例患者（平均年龄45.3岁），平均随访31.8个月。评估了有关适应证、跨越的节段、移植长度、愈合时间和并发症的详细情况。
术前诊断包括转移性或原发性肿瘤（13例）以及慢性骨髓炎继发的进行性后凸畸形（2例）、损伤（1例）、先天性畸形（1例）或植入物失败（1例）。平均融合4.4个节段，切除1.9个椎体。所有18例融合均包括各种形式的同种异体骨和/或自体骨材料，除带血管蒂肋骨移植外，12例患者还使用了内固定器械。肋骨平均长度为16.1 cm，根据脊柱重建的位置使用第5至第11肋中的一根肋骨。平均愈合时间为6.8个月，所有肋骨移植均愈合。没有与肋骨采集过程相关的并发症。
在复杂脊柱重建中使用带血管蒂肋骨移植对整个手术增加的时间很少，发病率低，似乎给患者带来了很大益处。
