青少年特发性脊柱侧凸手术中使用椎板下带的骨替代物：有用吗？一项病例对照研究。
Bone substitutes in adolescent idiopathic scoliosis surgery using sublaminar bands: is it useful? A case-control study.
作者信息
Pesenti Sebastien, Ghailane Soufiane, Varghese Jeffrey J, Ollivier Matthieu, Peltier Emilie, Choufani Elie, Bollini Gerard, Blondel Benjamin, Jouve Jean-Luc
机构信息
Spine Research Laboratory, Hospital for Special Surgery, New York, NY, USA.
Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, Marseille, France.
出版信息
Int Orthop. 2017 Oct;41(10):2083-2090. doi: 10.1007/s00264-017-3512-4. Epub 2017 May 24.
INTRODUCTION
In order to avoid pseudarthrosis in adolescent idiopathic (AIS) patients, it is recommended to bring additional bone graft or substitute. Modern rigid instrumentations have been shown to provide less pseudarthroses even without bone substitutes. The aim of our study was to determine the impact of using bones substitutes on fusion rates in adolescent idiopathic scoliosis patients undergoing PSF with sublaminar bands.
METHOD
AIS patients scheduled to undergo PSF with sublaminar bands were prospectively enrolled into this study and not given any bone substitutes (no-substitute group). Data were collected and analyzed in patients with at least two years of follow-up. Pseudarthrosis was diagnosed if at least one of the following was present: persistent back pain, hardware failure, loss of correction greater than 10°. The results were compared to a control group who received bone substitutes for the same surgical procedure.
RESULTS
Eighty-eight patients were included. For the whole cohort, the mean age was 14.8 years old and the mean follow-up was 30.9 months. For the 'no-substitute' group (n = 44), the mean Cobb angle was 56° pre-operatively, 20.1° post-operatively, and 22° at final follow-up. The fusion rate was not statistically different between the two groups (97.7% vs 95.5%, p = 0.56). At last follow-up, one pseudarthrosis occurred in the 'no substitute' group and two in the control group.
DISCUSSION
This is the first study to determine the impact of bone substitutes in AIS fusion using sublaminar bands. In our study, the use of local autologous bone graft alone resulted in a fusion rate of 97.7% despite the use of more flexible instrumentation. The high rate of fusion in AIS patients is more probably due to the healing potential of these young patients rather than to the type of instrumentation.
CONCLUSION
The use of additional bone graft or bone substitutes may not be mandatory when managing AIS.
LEVEL OF EVIDENCE
引言
为避免青少年特发性脊柱侧弯（AIS）患者出现假关节，建议使用额外的骨移植材料或替代物。现代刚性内固定器械已被证明即使不使用骨替代物也能减少假关节的发生。我们研究的目的是确定在接受椎板下带的后路脊柱融合术（PSF）的青少年特发性脊柱侧弯患者中使用骨替代物对融合率的影响。
方法
计划接受椎板下带PSF的AIS患者被前瞻性纳入本研究，且未给予任何骨替代物（无替代物组）。收集并分析至少随访两年的患者数据。如果出现以下至少一项情况，则诊断为假关节：持续背痛、内固定失败、矫正度丢失大于10°。将结果与接受相同手术且使用骨替代物的对照组进行比较。
结果
共纳入88例患者。整个队列的平均年龄为14.8岁，平均随访时间为30.9个月。“无替代物”组（n = 44）术前平均Cobb角为56°，术后为20.1°，末次随访时为22°。两组的融合率无统计学差异（97.7%对95.5%，p = 0.56）。在末次随访时，“无替代物”组发生1例假关节，对照组发生2例假关节。
讨论
这是第一项确定骨替代物在使用椎板下带的AIS融合中的影响的研究。在我们的研究中，尽管使用了更灵活的内固定器械，但仅使用局部自体骨移植的融合率仍达到97.7%。AIS患者的高融合率更可能是由于这些年轻患者的愈合潜力，而非内固定器械的类型。
结论
在治疗AIS时，可能无需使用额外的骨移植材料或骨替代物。
证据级别
4级。
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