Ilharreborde Brice, Morel Etienne, Fitoussi Franck, Presedo Ana, Souchet Philippe, Penneçot Georges-François, Mazda Keyvan
Department of Pediatric Orthopedics, Robert Debré Hospital, Paris, France.
J Pediatr Orthop. 2008 Apr-May;28(3):347-51. doi: 10.1097/BPO.0b013e318168d1d4.
Iliac crest autograft is currently the gold standard material for spinal fusion. However, its use is limited by additional operative time, increased blood loss, and morbidity. Recently, a synthetic osteoconductive bone graft material composed of bioactive glass has been described, with high effectiveness in animal models. Its ability to achieve spinal fusion in human has never been reported. The aim of this study was to compare bioactive glass and iliac crest autograft as bone substitutes in the treatment thoracic adolescent idiopathic scoliosis (AIS).
Eighty-eight consecutive patients underwent posterior spinal fusion for progressive thoracic AIS. There were 2 study groups based on the type of bone graft used: iliac crest autograft (n = 40) or bioglass (n = 48). A minimum 2-year follow-up was required. Medical data and radiographs were retrospectively analyzed and compared using unpaired t test and Mann-Whitney U test.
Mean follow-up was 40 months in the autograft group and 38 months in the bioglass group. In the autograft group, there were 2 infections (5%) and 3 mechanical failures (7.5%). One infection (2%) and 1 early mechanical failure (2%) occurred in the bioglass group. Loss of correction of the main thoracic curve between immediate postoperative and latest follow-up averaged 15.5% for autograft group and 11% for the bioglass group (P = 0.025). The mean (+/-SD) gain of frontal balance between immediate postoperative latest follow-up was 0.8 (+/-9.3) mm in the autograft group and 8.1 (+/-12) mm for the bioglass group (P = 0.005).
Results of this retrospective study suggest that bioglass is as effective as iliac crest graft to achieve fusion and maintain correction in AIS. Less complications were seen in the bioactive glass group, but the difference did not reach statistical significance. Bioactive glass can be proposed in the treatment of AIS, avoiding the morbidity of iliac crest harvesting. However, clinical and radiological outcomes need to be confirmed at long-term follow-up.
Level III.
目前，髂嵴自体骨移植是脊柱融合的金标准材料。然而，其应用受到额外手术时间、出血量增加和发病率上升的限制。最近，一种由生物活性玻璃组成的合成骨传导性骨移植材料已被描述，在动物模型中具有高效性。其在人体中实现脊柱融合的能力从未被报道过。本研究的目的是比较生物活性玻璃和髂嵴自体骨作为骨替代物在治疗青少年特发性胸椎侧弯（AIS）中的效果。
88例连续患者接受了后路脊柱融合术治疗进展性胸椎AIS。根据所使用的骨移植类型分为2个研究组：髂嵴自体骨组（n = 40）或生物玻璃组（n = 48）。需要至少2年的随访。对医学数据和X线片进行回顾性分析，并使用非配对t检验和曼-惠特尼U检验进行比较。
自体骨组平均随访40个月，生物玻璃组平均随访38个月。自体骨组发生2例感染（5%）和3例机械故障（7.5%）。生物玻璃组发生1例感染（2%）和1例早期机械故障（2%）。自体骨组术后即刻至最新随访期间主胸弯矫正丢失平均为15.5%，生物玻璃组为11%（P = 0.025）。自体骨组术后即刻至最新随访期间额状面平衡的平均（±标准差）增加为0.8（±9.3）mm，生物玻璃组为8.1（±12）mm（P = 0.005）。
这项回顾性研究的结果表明，生物活性玻璃在实现AIS融合和维持矫正方面与髂嵴移植同样有效。生物活性玻璃组的并发症较少，但差异未达到统计学意义。生物活性玻璃可用于治疗AIS，避免髂嵴取材的并发症。然而，临床和影像学结果需要长期随访来证实。
III级。
