回顾性分析长节段前路融合至骶骨
A retrospective review of long anterior fusions to the sacrum.
机构信息
Department of Orthopaedic Surgery, University of California, San Diego, 200 W. Arbor Drive, #8894, San Diego, CA 92103-8894, USA.
出版信息
Spine J. 2011 Apr;11(4):290-4. doi: 10.1016/j.spinee.2011.02.004.
BACKGROUND CONTEXT
In the setting of tumor, infection, or trauma, a corpectomy of the L5 vertebral body may be necessary. However, the space has an irregular trapezoidal shape, and the failure to account for this may lead to improper fitting of the titanium cages or the allograft struts when performing a reconstruction.
PURPOSE
The purpose of this study was to evaluate the failure rate of implants used to reconstruct the anterior lumbar spine when an L5 corpectomy has been performed.
METHODS
A retrospective review of the medical records and radiographs of 19 consecutive patients undergoing an L5 corpectomy and anterior spinal fusion was performed. The radiographs were reviewed for implant failure and successful fusions.
RESULTS
Cases included osteomyelitis (13), fractures (4), and tumor (2). Anterior reconstruction was performed with a straight cylindrical titanium cage in six cases, allograft in six cases, iliac crest bone graft (ICBG) in two cases, and cages with lordosis built into the cage or end plates in five cases. In the six straight cylindrical titanium cages, four cases had displaced anteriorly, necessitating revision surgery. In the other two cases, both had poor fixation to the sacrum and developed nonunions. In the six reconstructed with allograft, all three fibular struts developed nonunions. In the three reconstructed with humeral or femoral allograft, all patients formed a solid fusion. In the patients reconstructed with ICBG, one formed a nonunion, whereas the other one formed a solid fusion. In the cages with lordosis built into the cage or end plates, all five developed solid fusions.
CONCLUSIONS
A corpectomy of L5 resulting in an irregular trapezoidal shape must be accounted for when performing the reconstruction. Use of straight cylindrical cages or allograft with small footprints may lead to an increased rate of failure. When performing the reconstruction, adding approximately 20° to 30° of lordosis to the construct may create a better fit and increase stability and result in an improved fusion rate. If using allograft, using a larger graft with greater end plate contact may also improve fusion rates.
背景
在肿瘤、感染或创伤的情况下，可能需要进行 L5 椎体切除术。然而，该部位的空间呈不规则的梯形，若在进行重建时未能考虑到这一点，可能会导致钛笼或同种异体支柱的适配不当。
目的
本研究旨在评估在进行 L5 椎体切除术时，用于重建前腰椎的植入物的失败率。
方法
对 19 例连续行 L5 椎体切除术和前路脊柱融合术的患者的病历和影像学资料进行回顾性分析。对影像学资料进行评估，以了解植入物失败和融合成功的情况。
结果
病例包括骨髓炎（13 例）、骨折（4 例）和肿瘤（2 例）。采用直圆柱形钛笼进行前路重建 6 例，同种异体移植 6 例，髂嵴骨移植 2 例，带有前凸内置在笼或终板中的笼 5 例。在 6 例直圆柱形钛笼中，有 4 例发生了向前移位，需要进行翻修手术。在另外 2 例中，均与骶骨固定不良，出现了不愈合。在 6 例用同种异体移植重建的病例中，3 例腓骨支柱均出现了不愈合。在 3 例用肱骨或股骨同种异体移植重建的病例中，所有患者均形成了坚实的融合。在使用髂嵴骨移植重建的病例中，1 例出现了不愈合，而另 1 例则形成了坚实的融合。在带有内置前凸的笼或终板的 5 例笼中，所有患者均形成了坚实的融合。
结论
在进行重建时，必须考虑到 L5 的椎体切除术导致的不规则梯形形状。使用直圆柱形笼或足迹较小的同种异体移植可能会增加失败率。在进行重建时，在构建物中增加约 20°至 30°的前凸可能会更好地适配，增加稳定性，并提高融合率。如果使用同种异体移植，使用更大的移植体并增加与终板的接触面积，也可能提高融合率。
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