Fuller D A, Stevenson S, Emery S E
Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA.
Spine (Phila Pa 1976). 1996 Sep 15;21(18):2131-6. doi: 10.1097/00007632-199609150-00015.
An anterior interbody fusion was performed in the canine thoracic spine. Either calcium carbonate or autologous iliac crest bone graft was used to fill a surgically created spinal defect between T7 and T8. Some of the spines were stabilized intraoperatively with anterior instrumentation. Four experimental arthrodesis groups were studied: iliac crest bone graft with or without instrumentation and ceramic with or without instrumentation.
To evaluate the effects of internal fixation on an anterior interbody fusion using calcium carbonate ceramic, and to compare this with autologous iliac crest bone grafting.
Bone grafting can be associated with significant morbidity, and an acceptable substitute material is sought. In vivo analysis of ceramic as a substitute has revealed fracture and failure of the implant. Creating a stable environment with internal fixation may improve the performance of ceramic as a bone graft substitute.
Fusions were evaluated in 20 adult beagles 8 weeks after surgery. Structural properties of the fusion segment were evaluated with biomechanical testing. Histologic analysis was performed to determine junction healing, new bone formation, and revascularization.
Fusion segments with iliac crest bone graft and instrumentation were significantly stiffer than the other three groups in all tested modes of angular deformation. Greater junction healing was seen when instrumentation was used with iliac crest bone graft. Greater junction healing, new bone formation, and revascularization were observed when instrumentation was used with calcium carbonate ceramic. Most of the ceramic implants without fixation demonstrated near complete isolation with no revascularization.
Internal fixation resulted in histologically and biomechanically superior healing of autologous iliac crest bone graft in this canine model of anterior interbody fusion. Although fixation did not statistically improve the biomechanical properties of ceramic fusion segments, it had a profound effect on the ability of the ceramic to be revascularized and remodeled. Porous ceramic bone graft substitutes appear to depend on a stable environment for incorporation.
在犬类胸椎进行前路椎间融合术。使用碳酸钙或自体髂嵴骨移植来填充T7和T8之间手术造成的脊柱缺损。部分脊柱在术中采用前路内固定器械进行固定。研究了四个实验性融合组：使用或不使用内固定器械的髂嵴骨移植组以及使用或不使用内固定器械的陶瓷组。
评估内固定对使用碳酸钙陶瓷进行前路椎间融合的效果，并将其与自体髂嵴骨移植进行比较。
骨移植可能会伴有显著的并发症，因此人们一直在寻找可接受的替代材料。对陶瓷作为替代材料的体内分析显示植入物存在骨折和失效情况。通过内固定创造一个稳定的环境可能会改善陶瓷作为骨移植替代物的性能。
在20只成年比格犬术后8周对融合情况进行评估。通过生物力学测试评估融合节段的结构特性。进行组织学分析以确定融合愈合、新骨形成和血管再生情况。
在所有测试的角度变形模式下，使用髂嵴骨移植并进行内固定的融合节段比其他三组明显更硬。当髂嵴骨移植与内固定器械联合使用时，融合愈合情况更好。当碳酸钙陶瓷与内固定器械联合使用时，观察到更好的融合愈合、新骨形成和血管再生。大多数未进行固定的陶瓷植入物显示出几乎完全隔离且无血管再生。
在这个犬类前路椎间融合模型中，内固定在组织学和生物力学方面导致自体髂嵴骨移植的愈合更优。尽管固定在统计学上并未改善陶瓷融合节段的生物力学性能，但它对陶瓷的血管再生和重塑能力有深远影响。多孔陶瓷骨移植替代物似乎依赖于一个稳定的环境来实现融合。
