Department of Orthopedic Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China.
Spine (Phila Pa 1976). 2011 Jan 1;36(1):E20-6. doi: 10.1097/BRS.0b013e3181d323c6.
An experimental animal study with randomized, control design was conducted using a dog model. OBJECTIVE.: To construct a novel posterior lumbar spine fusion model with orthotopic paraspinal muscle-pediculated bone flaps and to compare with the conventional posterolateral lumbar intertransverse process fusion.
Previous studies have demonstrated that paraspinal musculature provided important vascular ingrowth into the fusion mass. However, the blood supply of paraspinal muscles was still not sufficiently used in spinal fusion. In this study, we assessed the significant role of orthotopic paraspinal muscle-pediculated bone flaps in the healing of bone graft in spinal fusion.
Thirty-two mongrel dogs were randomly assigned to 2 groups to undergo either posterior spinal fusion with orthotopic paraspinal muscle-pediculated bone flaps (treatment group) or posterolateral intertransverse process fusion (control group) at L5-L6 segment. All the fusions used an autologous bone graft obtained from bilateral posterior iliac crests. The animals were killed at 8 weeks or 16 weeks after surgery. The lumbar spines were evaluated by radiology, histology, and biomechanics.
Treatment groups showed an increasing trend on radiographic grades, manual palpation, and biomechanical stiffness compared with control groups at 8 and 16 weeks. Histologic analysis revealed that there was more mature woven bone in the treatment group than the controls at both points. At 8 weeks, the histologic fusion rate was 21.4% in the treatment group, 50% in the control group (P < 0.05); and at 16 weeks the fusion rate was 50% and 87.5% in the control group and the treatment group, respectively (P < 0.05).
The use of orthotopic paraspinal musclepediculated bone flaps increased the rate and quality of fusion in the experimental spinal fusion model. This suggested that the novel posterior spinal fusion could be further developed for clinical application.
采用随机对照实验动物研究，建立犬模型，构建一种新的后路腰椎融合模型，采用原位脊柱旁肌蒂骨瓣，并与传统后路经椎间孔腰椎间融合术进行比较。
先前的研究表明，脊柱旁肌肉为融合块提供了重要的血管生长。然而，在脊柱融合中，脊柱旁肌肉的血液供应仍未得到充分利用。在本研究中，我们评估了原位脊柱旁肌蒂骨瓣在脊柱融合中骨移植物愈合中的重要作用。
32 只杂种犬随机分为两组，分别在 L5-L6 节段行后路脊柱融合术，采用原位脊柱旁肌蒂骨瓣（治疗组）或后路经椎间孔腰椎间融合术（对照组）。所有融合均采用双侧髂后嵴自体骨移植物。术后 8 周和 16 周处死动物，对腰椎进行影像学、组织学和生物力学评估。
与对照组相比，治疗组在 8 周和 16 周时的影像学分级、手法触诊和生物力学刚度均呈上升趋势。组织学分析显示，治疗组在两个时间点均有更多成熟的编织骨。8 周时，治疗组的组织学融合率为 21.4%，对照组为 50%（P<0.05）；16 周时，对照组和治疗组的融合率分别为 50%和 87.5%（P<0.05）。
采用原位脊柱旁肌蒂骨瓣可提高实验性脊柱融合模型的融合率和质量。这表明新型后路脊柱融合术可能进一步应用于临床。
