Hillard Virany Huynh, Fassett Daniel R, Finn Michael A, Apfelbaum Ronald I
Department of Neurosurgery, University of Utah, Salt Lake City, Utah 84132, USA.
J Neurosurg Spine. 2009 Oct;11(4):396-401. doi: 10.3171/2009.5.SPINE08662.
An iliac crest autograft is the gold standard for bone grafting in posterior atlantoaxial arthrodesis but can be associated with significant donor-site morbidity. Conversely, an allograft has historically performed suboptimally for atlantoaxial arthrodesis as an onlay graft. The authors have modified a bone grafting technique to allow placement of a bicortical iliac crest allograft in an interpositional manner, and they evaluated it as an alternative to an autograft in posterior atlantoaxial arthrodesis.
The records of 89 consecutive patients in whom C1-2 arthrodesis was performed between 2001 and 2005 were reviewed.
Forty-seven patients underwent 48 atlantoaxial arthrodeses with an allograft (mean follow-up 16.1 months, range 0-49 months), and 42 patients underwent autograft bone grafting (mean follow-up 17.6 months, range 0-61.0 months). The operative time was 50 minutes shorter in the allograft (mean 184 minutes, range 106-328 minutes) than in the autograft procedure (mean 234 minutes, range 154-358 minutes), and the estimated blood loss was 50% lower in the allograft group than in the autograft group (mean 103 ml [range 30-200 ml] vs mean 206 ml [range 50-400 ml], respectively). Bone incorporation was initially slower in the allograft than in the autograft group but equalized by 12 months postprocedure. The respective fusion rates after 24 months were 96.7 and 88.9% for autografts and allografts. Complications at the donor site occurred in 16.7% of the autograft patients, including 1 pelvic fracture, 1 retained sponge, 1 infection, 2 hernias requiring repair, 2 hematomas, and persistent pain.
The authors describe a technique for interpositional bone grafting between C-1 and C-2 that allows for the use of an allograft with excellent fusion results. This technique reduced the operative time and blood loss and eliminated donor-site morbidity.
自体髂嵴骨移植是后路寰枢椎融合术中骨移植的金标准，但可能伴有明显的供区并发症。相反，同种异体骨作为覆盖移植用于寰枢椎融合术，其历史表现欠佳。作者改良了一种骨移植技术，使双皮质髂嵴同种异体骨能够以嵌入方式植入，并将其作为后路寰枢椎融合术中自体骨移植的替代方法进行评估。
回顾了2001年至2005年间连续89例行C1-2融合术患者的病历。
47例患者接受了48次同种异体骨寰枢椎融合术（平均随访16.1个月，范围0 - 49个月），42例患者接受了自体骨移植（平均随访17.6个月，范围0 - 61.0个月）。同种异体骨移植的手术时间（平均184分钟，范围106 - 328分钟）比自体骨移植手术（平均234分钟，范围154 - 358分钟）短50分钟，同种异体骨移植组的估计失血量比自体骨移植组低50%（分别为平均103 ml[范围30 - 200 ml]和平均206 ml[范围50 - 400 ml]）。同种异体骨的骨融合最初比自体骨移植组慢，但术后12个月时达到相同水平。自体骨移植和同种异体骨移植术后24个月的融合率分别为88.9%和96.7%。16.7%的自体骨移植患者出现供区并发症，包括1例骨盆骨折、1例海绵遗留、1例感染、2例需要修复的疝气、2例血肿和持续性疼痛。
作者描述了一种在C-1和C-2之间进行嵌入性骨移植的技术，该技术允许使用同种异体骨，融合效果良好。该技术缩短了手术时间，减少了失血量，并消除了供区并发症。
