Department of Plastic and Reconstructive Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Scand J Surg. 2013;102(1):42-8. doi: 10.1177/145749691310200109.
The use of free vascularised bone grafts is an infrequently performed surgical technique for the reconstruction of spinal defects. This field of surgery brings many challenges concerning the choice of free vascularised bone graft, planning of the operative procedure and selection of recipient vessels. This study aims to report our experience with free vascularised bone grafts, with special emphasis on the surgical approach and the selection of recipient vessels. Over a period of 17 years (1994-2011), we used these grafts for anterior spinal reconstruction in 30 patients. In 28 patients, a free vascularised fibular graft was used, and in two cases a free vascularised iliac crest graft was used. The spinal segments reconstructed involved the cervical or cervicothoracic spine (6 cases), the thoracic spine (11 cases) and the thoracolumbar and lumbosacral spine (13 cases). Revascularisation of the free vascularised bone graft proved to be technically feasible in 30 patients, but failed in one fibular graft due to difficulties with recipient vessels in the lumbar region. Technical challenges were met with respect to the choice of the recipient vessel at various anatomical sites. Availability of acceptor vessels was highly de-pendant of the type of surgery (resection or stabilisation) and the selected surgical approach. Based on these findings, a preferred approach is given for each region. The use of free vascularised bone grafts is a valuable technique for the reconstruction of complex spinal disorders. Successful execution requires microvascular expertise with respect to graft harvesting and appropriate choice of recipient vessels. Adequate preoperative planning in a multidisciplinary setting and adherence to the basic principles for spinal reconstruction are required.
游离血管化骨移植是一种不常施行的手术技术，用于重建脊柱缺损。该手术领域涉及到游离血管化骨移植的选择、手术方案的规划和受区血管的选择等诸多挑战。本研究旨在报告我们在游离血管化骨移植方面的经验，特别强调手术入路和受区血管的选择。在 17 年的时间里（1994 年至 2011 年），我们使用这些移植物对 30 例患者进行了前路脊柱重建。在 28 例患者中，使用了游离腓骨移植，在 2 例患者中使用了游离髂嵴移植。重建的脊柱节段涉及颈椎或颈胸段（6 例）、胸椎（11 例）和胸腰椎及腰骶段（13 例）。在 30 例患者中，游离血管化骨移植的再血管化被证明在技术上是可行的，但在 1 例腓骨移植中失败，原因是在腰椎区受区血管存在困难。在不同的解剖部位选择受区血管时，遇到了技术挑战。接受血管的可用性高度依赖于手术类型（切除或稳定）和选择的手术入路。基于这些发现，我们为每个区域提供了首选的入路。游离血管化骨移植是重建复杂脊柱疾病的一种有价值的技术。成功实施需要在移植采集和适当选择受区血管方面具有微血管专业知识。需要在多学科环境中进行充分的术前规划，并遵守脊柱重建的基本原则。
