Ackerman Duncan B, Rose Peter S, Moran Steven L, Dekutoski Mark B, Bishop Allen T, Shin Alexander Y
Department of Orthopedic Surgery and Plastic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
J Spinal Disord Tech. 2011 May;24(3):170-6. doi: 10.1097/BSD.0b013e3181e666d0.
Retrospective review.
To determine outcomes after anterior or posterior placement of vascularized-free fibular grafts in complex spinal reconstruction for tumor resection and osteomyelitis and to evaluate the results with respect to bony fusion, time to union, and complications.
Biological reconstruction of segmental defects of the spinal column may be required when multiple vertebrae are resected for tumor or infection. Published series to date have not fully addressed surgical techniques or outcome and complications.
A retrospective, Institutional Review Board-approved review was performed on the medical records and neuroimaging of all patients who underwent a vascularized-free fibular graft for a multisegmental spine reconstruction at a single institution over the last 10 years. Details regarding indications, the levels spanned, the graft length, and the time to union were evaluated.
Seven patients (mean age, 43 y) underwent surgery using this technique, with an average follow-up of 38 months. Surgical indications included oncologic resection associated with radiation therapy (n=3) and surgical treatment of vertebral osteomyelitis (n=4). An average of 2.7 (median, 2) levels was fused with an average of 2.1 (median, 2) vertebral body excisions performed. Mean fibular length was 19.1 cm. Six of 7 patients achieved union at mean of 3.2 months. Complications specific to the fibular grafting procedure included 1 nonunion associated with pedicle thrombosis.
Vascularized-free fibular grafts are effective in the treatment of complex spinal reconstruction after surgery for spinal tumors or osteomyelitis. The vascularized-free fibular graft adds structural support as well as living bone to the fusion site and is a reasonable alternative to nonvascularized grafts in locally compromised surgical beds.
回顾性研究。
确定在复杂脊柱重建中，为肿瘤切除和骨髓炎进行带血管游离腓骨移植前路或后路植入后的结果，并评估骨融合、愈合时间和并发症方面的结果。
当因肿瘤或感染切除多个椎体时，可能需要对脊柱节段性缺损进行生物重建。迄今为止，已发表的系列研究尚未充分探讨手术技术、结果及并发症。
对过去10年在单一机构接受带血管游离腓骨移植进行多节段脊柱重建的所有患者的病历和神经影像进行回顾性研究，该研究经机构审查委员会批准。评估了有关适应症、跨越节段、移植长度和愈合时间的详细信息。
7例患者（平均年龄43岁）采用该技术进行手术，平均随访38个月。手术适应症包括与放疗相关的肿瘤切除（n = 3）和椎体骨髓炎的手术治疗（n = 4）。平均融合2.7（中位数2）个节段，平均进行2.1（中位数2）个椎体切除。腓骨平均长度为19.1 cm。7例患者中有6例平均在3.2个月时实现愈合。腓骨移植手术特有的并发症包括1例与椎弓根血栓形成相关的骨不连。
带血管游离腓骨移植在脊柱肿瘤或骨髓炎手术后的复杂脊柱重建治疗中有效。带血管游离腓骨移植为融合部位增加了结构支撑以及活骨，在局部条件不佳的手术床中是无血管移植的合理替代方案。
