Erdem Mehmet Nuri, Kultur Yigit, Akar Abdulhalim, Aydogan Mehmet
Orthopedics and Traumatology, Yeni Yuzyil University Gaziosmanpasa Hospital, Istanbul, Turkey.
Department of Spine Surgery, Memorial Sisli Hospital, Istanbul, Turkey.
Medicine (Baltimore). 2025 Jul 25;104(30):e42443. doi: 10.1097/MD.0000000000042443.
Adolescent idiopathic scoliosis (AIS) is a common spinal deformity usually treated with a surgical procedure comprising spinal fusion. Solid fusion after such surgery is important for the overall success of the procedure, where graft selection is also a significant factor. Allografts are as effective as autografts in the adolescent patient population; however, a major limitation is their high cost. The purpose of this investigation was to reassess the necessity for allografts when surgically treating AIS and compare the results between the use of only local autograft and a combination of autograft and allograft. Fifty-four patients with AIS with minimum follow-up of 2 years were assigned to 2 groups and analyzed. In 28 patients with a mean age of 14.2 years, local autografts harvested from the thoracic and lumbar vertebrae facet joints were used (autograft group). Over the top and bottom 3 segments of the fusion site, grafts were placed. Various combinations of autografts and allografts were applied over all fusion levels in 26 patients with a mean age of 15.1 years (allograft group). The mean follow-up period was 45.2 months in the autograft and 45.7 months in the allograft group. Mean 59.8 cc of freeze-dried crushed cancellous graft was used in the allograft group. The surgical outcomes were compared between the autograft and allograft groups. The mean of the major curvature angle is preoperatively measured as (59.9°, 63.9°); early postoperatively (11.5°, 13.8°) and (16.5°, 18.5°) at the final follow-up visit. Curve correction was calculated early postoperatively as 81.2%, 79.4%, 73.0%, and 72.3% at the last follow-up, respectively. All patients in both groups attained fusion. The major disadvantages in the use of allografts these days is the increased surgical cost. Our grafting technique thus demonstrated that allografts are not necessary as local autografts when used correctly would achieve fusion.
青少年特发性脊柱侧凸（AIS）是一种常见的脊柱畸形，通常通过包括脊柱融合在内的外科手术进行治疗。此类手术后的牢固融合对于手术的整体成功至关重要，其中移植物的选择也是一个重要因素。在青少年患者群体中，同种异体移植物与自体移植物的效果相同；然而，一个主要限制是其成本高昂。本研究的目的是重新评估手术治疗AIS时使用同种异体移植物的必要性，并比较仅使用局部自体移植物与自体移植物和同种异体移植物联合使用的结果。将54例AIS患者（最短随访2年）分为2组并进行分析。28例平均年龄为14.2岁的患者使用了从胸腰椎小关节采集的局部自体移植物（自体移植物组）。在融合部位的上下3个节段放置移植物。26例平均年龄为15.1岁的患者在所有融合节段应用了自体移植物和同种异体移植物的各种组合（同种异体移植物组）。自体移植物组的平均随访期为45.2个月，同种异体移植物组为45.7个月。同种异体移植物组平均使用了59.8 cc冻干碎松质骨移植物。比较了自体移植物组和同种异体移植物组的手术结果。主弯角度术前平均值为（59.9°，63.9°）；术后早期为（11.5°，13.8°），末次随访时为（16.5°，18.5°）。术后早期的曲线矫正率分别为81.2%、79.4%、73.0%和末次随访时的72.3%。两组所有患者均实现了融合。目前使用同种异体移植物的主要缺点是手术成本增加。我们的植骨技术表明，同种异体移植物并非必需，因为正确使用局部自体移植物即可实现融合。
