Aliano Kristen A, Agulnick Marc, Cohen Benjamin, Gonya Gary, Low Christopher, Stavrides Steve, Addona Tommaso, Goncalves John, Shin David, Kilgo Matthew S, Davenport Thomas A
Long Island Plastic Surgical Group, Garden City, NY, USA.
Reconstructive Spine Surgery,, Garden City, NY.
Microsurgery. 2013 Oct;33(7):560-6. doi: 10.1002/micr.22150. Epub 2013 Sep 6.
Reconstruction of bony defects in the surgical management of vertebral osteomyelitis is a challenging endeavor. Our objective is to report the use of intra-abdominal vessels as the recipient vessels for microanastomosis of vascularized bone graft and the use of a spinal cage for fixation. Three patients failed conservative treatment for vertebral osteomyelitis and suffered pathologic fracture. Their treatment consisted of staged posterior irrigation and debridement with segmental fixation, followed by a thoracoabdominal approach multiple-level corpectomy. Reconstruction was performed with a free vascularized fibular graft placed within a custom, expandable cage. The vascularized fibular graft was anastomosed to an intra-abdominal recipient vessel. All patients improved clinically with no neurologic deficits noted. All showed evidence of successful fusion. Free vascularized bone grafts continue to be an excellent option for multi-level spinal defects related to osteomyelitis. Intra-abdominal recipient vessels are appropriate recipient vessels, as their diameter, length, and accessibility allow vascularized bone graft reconstruction of vertebral column defects of the thoracolumbar region. These vessels are also easily accessible and the anastomoses can be performed in the superficial operating incision.
在椎体骨髓炎的外科治疗中，骨缺损的重建是一项具有挑战性的工作。我们的目的是报告使用腹内血管作为吻合血管的骨移植显微吻合的受区血管，以及使用椎间融合器进行固定。三名椎体骨髓炎患者保守治疗失败并发生病理性骨折。他们的治疗包括分期后路冲洗清创并节段固定，随后采用胸腹联合入路进行多节段椎体次全切除术。使用置于定制可扩张椎间融合器内的游离带血管腓骨移植进行重建。将带血管腓骨移植与腹内受区血管吻合。所有患者临床症状均有改善，未发现神经功能缺损。所有患者均显示成功融合的迹象。游离带血管骨移植仍然是与骨髓炎相关的多节段脊柱缺损的极佳选择。腹内受区血管是合适的受区血管，因为它们的直径、长度和可达性允许对胸腰段脊柱缺损进行带血管骨移植重建。这些血管也易于显露，并且吻合可在浅表手术切口中进行。
