Erdmann Detlev, Meade Ricardo A, Lins Robert E, McCann Richard L, Richardson William J, Levin L Scott
Division of Plastic, Reconstructive, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Plast Reconstr Surg. 2006 Jun;117(7):2438-45; discussion 2446-7. doi: 10.1097/01.prs.0000219077.73229.af.
Several factors influence the osseous union of spinal fusions, including the substrate used for arthrodesis, the biology of the fusion bed, as well as local host factors. While cancellous bone grafting is useful in simple cases with no major bony defects, corticocancellous strut grafts are indicated in reconstructions requiring mechanical support. The size and location of the spinal defect to be reconstructed determine what type of vascularized bone graft is indicated. According to the literature, locations suitable for reconstruction using a microvascular free fibula graft include the cervical spine and, less frequently, the cervicothoracic, thoracic, thoracolumbar, and lumbar spine. Using the microvascular free vascularized fibula graft as a salvage procedure for failed anterior spine surgery due to bacterial spinal osteomyelitis has not been reported.
Four cases of spinal osteomyelitis after attempted spinal fusion are presented. In all cases, a microvascular free fibula graft was successfully used for secondary spinal fusion and clearance of documented bacterial osteomyelitis. The operative approach is described.
Use of the vascularized free fibula graft for correction of primary and secondary spinal deformities, as well as for reconstruction after excision of malignant spine tumors, has been well documented. On the basis of their experience, the authors also recommend microvascular fibula transplantation as a salvage procedure for failed anterior spine surgery due to chronic osteomyelitis.
多种因素会影响脊柱融合术的骨愈合，包括用于关节融合的基质、融合床的生物学特性以及局部宿主因素。虽然松质骨移植在无重大骨缺损的简单病例中有用，但皮质松质支撑骨移植适用于需要机械支撑的重建手术。待重建的脊柱缺损的大小和位置决定了应采用何种类型的带血管骨移植。根据文献，适合使用游离腓骨微血管移植进行重建的部位包括颈椎，较少见的还有颈胸段、胸段、胸腰段和腰椎。尚未有关于将游离腓骨微血管移植作为因细菌性脊柱骨髓炎导致前路脊柱手术失败后的挽救手术的报道。
本文介绍了4例脊柱融合术尝试后发生脊柱骨髓炎的病例。在所有病例中，游离腓骨微血管移植均成功用于二次脊柱融合及已确诊的细菌性骨髓炎的清除。文中描述了手术入路。
带血管游离腓骨移植用于矫正原发性和继发性脊柱畸形以及恶性脊柱肿瘤切除后的重建，已有充分的文献记载。基于他们的经验，作者还推荐将微血管腓骨移植作为因慢性骨髓炎导致前路脊柱手术失败后的挽救手术。
