Antoni Maxime, Charles Yann Philippe, Walter Axel, Schuller Sébastien, Steib Jean-Paul
Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, France.
J Spinal Disord Tech. 2015 Nov;28(9):E528-33. doi: 10.1097/BSD.0b013e3182aab2bf.
Retrospective CT analysis of anterior fusion in thoracolumbar trauma.
The aim of this study was to compare fusion rates of different bone grafts and to analyze risk factors for pseudarthrosis.
Interbody fusion is indicated in anterior column defects. Different grafts are used: autologous iliac crest, titanium mesh cages filled with cancellous bone, and autologous ribs. It is not clear which graft offers the most reliable fusion.
Radiologic data of 116 patients (71 men, 45 women) operated for type A2, A3, B, or C fractures were analyzed. The average age was 44.6 years (range, 16-75 y) and follow-up was 2.7 years (range, 1-9 y). All patients were treated by posterior instrumentation followed by an anterior graft: 53 cases with iliac crest, 43 cases with mesh cages, and 20 with rib grafts. Fusion was evaluated on CT and classified into complete fusion, partial fusion, unipolar pseudarthrosis, and bipolar pseudarthrosis.
Iliac crest fused in 66%, cages in 98%, and rib grafts in 90%. The fusion rate of cages filled with bone was significantly higher as the iliac graft fusion rate (P=0.002). The same was applied to rib grafts compared with iliac crest (P=0.041). Additional bone formation around the main graft, bridging both vertebral bodies, was observed in 31 of the 53 iliac crests grafts. Pseudarthrosis occurred more often in smokers (P=0.042). A relationship between fracture or instrumentation types, sex, age, BMI, and fusion could not be determined.
Tricortical iliac crest grafts showed an unexpected high pseudarthrosis rate in thoracolumbar injuries. Their cortical bone is dense and their fusion surface is small. Rib grafts led to a better fusion when used in combination with the cancellous bone from the fractured vertebral body. Titanium mesh cages filled with cancellous bone led to the highest fusion rate and built a complete bony bridge between vertebral bodies. Smoking seemed to influence fusion.
Case control study, Level III.
胸腰椎创伤前路融合术的回顾性CT分析。
本研究旨在比较不同骨移植的融合率，并分析假关节形成的危险因素。
前路椎间融合术适用于前柱缺损。使用了不同的移植材料：自体髂嵴、填充松质骨的钛网笼和自体肋骨。目前尚不清楚哪种移植材料能提供最可靠的融合效果。
分析了116例接受A2、A3、B或C型骨折手术患者（71例男性，45例女性）的放射学数据。平均年龄为44.6岁（范围16 - 75岁），随访时间为2.7年（范围1 - 9年）。所有患者均先行后路内固定，随后进行前路植骨：53例采用髂嵴植骨，43例采用网笼植骨，20例采用肋骨植骨。通过CT评估融合情况，并分为完全融合、部分融合、单极假关节和双极假关节。
髂嵴植骨融合率为66%，网笼植骨为98%，肋骨植骨为90%。填充骨的网笼融合率显著高于髂嵴植骨融合率（P = 0.002）。与髂嵴植骨相比，肋骨植骨情况相同（P = 0.041）。在53例髂嵴植骨中，有31例观察到主要移植材料周围有额外的骨形成，跨越两个椎体。假关节在吸烟者中更常见（P = 0.042）。无法确定骨折或内固定类型、性别、年龄、BMI与融合之间的关系。
三皮质髂嵴植骨在胸腰椎损伤中显示出意外的高假关节率。其皮质骨致密，融合面小。肋骨植骨与骨折椎体的松质骨联合使用时，融合效果更好。填充松质骨的钛网笼融合率最高，并在椎体间形成完整的骨桥。吸烟似乎会影响融合。
病例对照研究，III级。
