Department of Orthopedic Surgery, Dokkyo Medical University School of Medicine, Tochigi, Japan.
Spine (Phila Pa 1976). 2013 Jan 1;38(1):44-50. doi: 10.1097/BRS.0b013e318261ec74.
Retrospective study.
To analyze the clinical outcomes of anterior and posterior spinal fusion (APSF) using a fibular strut autograft (FSAG) and to investigate the morphological changes in the reconstructed spinal column of dystrophic deformities in neurofibromatosis (NF)-1.
APSF is desirable for dystrophic deformities in NF-1 with more than 50° of dystrophic kyphosis. There are few reports regarding the clinical outcomes of APSF in which the morphological changes over time of the anterior strut graft have been investigated.
The clinical and radiographic outcomes of APSF with FSAG were investigated in 10 consecutive patients with dystrophic deformity in NF-1. For qualitative and quantitative analyses, the chronological changes in the FSAG configuration, length, and diameter were evaluated.
The mean follow-up period was 9 years, 9 months (range, 1-30 years). Graft bone erosion and postoperative curve progression were not observed in any patient. In quantitative analyses of the anterior strut, the mean ratio of the latest and immediately postoperative FSAG lengths was 0.98 (0.93-1.09). The mean central/peripheral ratios of the FSAG diameter (central portion/[upper end + lower end]/2) were 1.02 (0.92-1.10) immediately after surgery, and 1.01 (0.92-1.07) at the latest follow-up, with no significant change between these 2 time points (P = 0.937). The mean preoperative cross-sectional area of the apical vertebral body and its mean virtual cross-sectional area at the final follow-up were 3.80 (1.83-5.43) and 4.87 (2.46-7.00) cm(2), respectively, with a significant difference between these 2 parameters (P = 0.0078). The mean final/preoperative ratio was 1.31 (1.10-1.43).
APSF with FSAG for dystrophic deformity in NF-1 successfully reconstructed a reliable spinal column with a rich bone stock. The FSAG and surrounding vertebral bodies were free from postoperative erosion due to dystrophic changes and maintained their stability for a long time.
回顾性研究。
分析使用腓骨支柱自体移植物（FSAG）进行前后脊柱融合（APSF）的临床结果，并研究神经纤维瘤病 1 型（NF-1）中营养不良性畸形重建脊柱的形态学变化。
对于 NF-1 中超过 50°的营养不良性后凸畸形，APSF 是理想的选择。关于 APSF 的临床结果的报道很少，其中已经研究了随时间推移前支柱移植物的形态变化。
对 10 例 NF-1 中营养不良性畸形患者进行 APSF 与 FSAG 的临床和影像学结果研究。为了进行定性和定量分析，评估 FSAG 结构、长度和直径的随时间变化。
平均随访时间为 9 年 9 个月（1-30 年）。在任何患者中均未观察到移植物骨侵蚀和术后曲线进展。在前支柱的定量分析中，FSAG 最新长度与术后即刻长度的平均比值为 0.98（0.93-1.09）。FSAG 直径的中央/外周比（中央部分/[上端+下端]/2）在术后即刻为 1.02（0.92-1.10），在末次随访时为 1.01（0.92-1.07），这两个时间点之间没有明显变化（P=0.937）。术前顶椎体的横截面积和末次随访时的虚拟横截面积平均值分别为 3.80（1.83-5.43）和 4.87（2.46-7.00）cm²，两者之间有显著差异（P=0.0078）。平均最终/术前比为 1.31（1.10-1.43）。
NF-1 中营养不良性畸形使用 FSAG 进行 APSF 成功地重建了具有丰富骨量的可靠脊柱。FSAG 和周围椎体由于营养不良性变化而免受术后侵蚀，并保持了长时间的稳定性。
