Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas, USA.
Oper Neurosurg (Hagerstown). 2021 Apr 15;20(5):497-501. doi: 10.1093/ons/opab035.
Pseudoarthrosis, or failure to achieve bony union, is a well-known complication of spinal fusion operations. Rates range from 5% to 40% and are influenced by both patient and technical factors. Patients who do not achieve complete fusion may experience a return or worsening of their preoperative pain. For patients with complicated pathologies, vascularized bone grafts (VBGs) have been shown to provide better outcomes than nonvascularized bone grafts (N-VBGs).
To enhance an instrumented spinal fusion by the innovative technique presented herein that utilizes a rotated, pedicled VBG from the left eighth rib under the paraspinous musculature into the midlumbar posterolateral gutter.
For posterior approaches, the rib can be easily accessed and rotated into the appropriate strut position. The rib is dissected out, identifying and preserving the neurovascular bundle medially. The rib is then tunneled medially and appropriately positioned as the spinal graft, with the curve providing anatomic kyphosis or lordosis, depending on the surgical location. It is then successfully fixated with plates and spinal screws.
In our limited experience to date, vascularized rib grafting procedures augment fusion and reduce operating room time and bleeding compared to free flap procedures. No patients have experienced complications related to these grafts.
Pedicled vascularized rib grafts can be utilized to provide the advantages of a vascularized bone flap in complicated pathologies requiring spinal fusion as far as the L2-L3 level, without the morbidity associated with free tissue transfer.
假关节，或未能实现骨性融合，是脊柱融合手术的已知并发症。发生率从 5%到 40%不等，受患者和技术因素的影响。未完全融合的患者可能会经历术前疼痛的复发或加重。对于患有复杂病变的患者，带血管骨移植物 (VBG) 已被证明比非血管骨移植物 (N-VBG) 提供更好的结果。
通过本文介绍的创新技术增强器械化脊柱融合，该技术利用从左侧第八肋骨旋转的带蒂 VBG，穿过棘旁肌肉进入中腰椎后外侧沟。
对于后入路，肋骨很容易触及并旋转到适当的支柱位置。肋骨被解剖出来，在中间识别和保护神经血管束。然后肋骨向内侧隧道并适当定位作为脊柱移植物，其曲线提供解剖性后凸或前凸，具体取决于手术位置。然后用钢板和脊柱螺钉成功固定。
在我们迄今为止的有限经验中，与游离皮瓣手术相比，带血管肋骨移植术可增加融合，并减少手术室时间和出血。没有患者因这些移植物而出现并发症。
带蒂血管化肋骨移植物可用于为需要脊柱融合的复杂病变提供血管化骨瓣的优势，范围远至 L2-L3 水平，而没有游离组织转移相关的发病率。
