Wetzel F T, Hoffman M A, Arcieri R R
Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, Hershey.
Yale J Biol Med. 1993 May-Jun;66(3):263-75.
Fifty-six patients who underwent anterior fusion utilizing fibular allograft are reviewed. Thirty-two patients underwent multiple-level anterior cervical discectomy and fusion utilizing fibular strut allograft, and 24 underwent anterior lumbar discectomy and fusion using fibular strut allograft. Cervical surgery was performed via the strut technique of Whitecloud and LaRocca and lumbar surgery was performed via a transperitoneal or retroperitoneal approach. Postoperatively, patients were assigned a clinical grade based on symptomatic relief and medication usage. X-rays were visually inspected, and quantitatively digitized for Cobb angle and translation in order to assess the status of arthrodesis. In the cervical group, the rate of clinical success (87.5%) exceeded the arthrodesis rate. By inspection, 65% fused, at a mean time of 23.5 months postoperatively. In the lumbar group, the overall clinical success rate was 68%. This correlated quite strongly with a fusion rate of 58%. Smoking was a negative correlate with arthrodesis. Patients receiving Workers' Compensation were also more likely to have an unsatisfactory clinical outcome. The results of this study highlight the difference between anterior arthrodesis in the cervical and lumbar spine. The biomechanical stability afforded by the fibular strut in the cervical spine appears to outweigh the disadvantages of delayed time to union. The rate of posterior cervical fusion to salvage symptomatic pseudoarthrosis was quite low (9.3%), thus suggesting that additional posterior surgery in this particular group of patients should not be considered for a minimum of two years postoperatively. In the lumbar group, status of arthrodesis correlated closely with clinical outcome. Fusion rate in this group was disappointing, corresponding to other reports in the literature. Based on these data, primary anterior body fusion without allograft in the lumbar spine cannot be recommended, as a viable alternative to conventional autograft.
对56例行腓骨同种异体骨前路融合术的患者进行了回顾性研究。32例患者接受了多节段颈椎间盘切除并使用腓骨支撑同种异体骨进行融合术，24例接受了腰椎间盘切除并使用腓骨支撑同种异体骨进行融合术。颈椎手术采用Whitecloud和LaRocca的支撑技术，腰椎手术采用经腹或腹膜后入路。术后，根据症状缓解情况和药物使用情况对患者进行临床分级。对X线片进行视觉检查，并对Cobb角和平移进行定量数字化，以评估融合状态。在颈椎组，临床成功率（87.5%）超过了融合率。经检查，65%的患者实现融合，平均术后时间为23.5个月。在腰椎组，总体临床成功率为68%。这与58%的融合率密切相关。吸烟与融合呈负相关。接受工伤赔偿的患者临床结局也更可能不理想。本研究结果突出了颈椎和腰椎前路融合术之间的差异。腓骨支撑在颈椎提供的生物力学稳定性似乎超过了融合延迟的缺点。后路颈椎融合挽救有症状假关节的发生率相当低（9.3%），因此表明在这组特定患者中，术后至少两年内不应考虑额外的后路手术。在腰椎组，融合状态与临床结局密切相关。该组的融合率令人失望，与文献中的其他报告一致。基于这些数据，不建议在腰椎进行无同种异体骨的前路椎体融合术作为传统自体骨移植的可行替代方案。
