Sawin P D, Traynelis V C, Menezes A H
Division of Neurosurgery, The University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
J Neurosurg. 1998 Feb;88(2):255-65. doi: 10.3171/jns.1998.88.2.0255.
Autogeneic bone graft is often incorporated into posterior cervical stabilization constructs as a fusion substrate. Iliac crest is used frequently, although donor-site morbidity can be substantial. Rib is used rarely, despite its accessibility, expandability, unique curvature, and high bone morphogenetic protein content. The authors present a comparative analysis of autogeneic rib and iliac crest bone grafts, with emphasis on fusion rate and donor-site morbidity.
A review was conducted of records and radiographs from 600 patients who underwent cervical spinal fusion procedures in which autogeneic bone grafts were used. Three hundred patients underwent rib harvest and posterior cervical fusion. The remaining 300 patients underwent iliac crest harvest (248 for an anterior cervical fusion and 52 for posterior fusion). The analysis of fusion focused on the latter subgroup; donor-site morbidity was determined by evaluating the entire group. Fusion criteria included bony trabeculae traversing the donor-recipient interface and long-term stability on flexion-extension radiographs. Graft morbidity was defined as any untoward event attributable to the graft harvest. Statistical comparisons were facilitated by using Fisher's exact test.
Demographic data obtained in both groups were comparable. Rib constructs were placed in the following regions: occipitocervical (196 patients), atlantoaxial (35 patients), and subaxial cervical spine (69 patients). Iliac crest grafts were placed in the occipitocervical (28 patients), atlantoaxial (10 patients), and subaxial cervical (14 patients) regions. Fusion occurred in 296 (98.8%) of 300 rib graft and 49 (94.2%) of 52 iliac crest graft constructs (p = 0.056). Graft morbidity was greater with iliac crest than with rib (p < 0.00001). Donor-site morbidity for the rib graft was 3.7% and included pneumonia (eight patients), persistent atelectasis (two patients), and superficial wound dehiscence (one patient). Pneumothorax, intercostal neuralgia, and chronic chest wall pain were not encountered. Iliac crest morbidity occurred in 25.3% of the patients and consisted of chronic donor-site pain (52 patients), wound dehiscence (eight patients), pneumonia (seven patients), meralgia paresthetica (four patients), hematoma requiring evacuation (three patients), and iliac spine fracture (two patients). Even when chronic pain was not considered, morbidity encountered in obtaining iliac crest still exceeded that encountered with rib harvest (p = 0.035). The fusion rate and donor-site morbidity for rib autograft compare favorably with those for iliac crest when used in posterior cervical constructs. To the authors' knowledge, this represents the largest series to date in which the safety and efficacy of using autogeneic bone graft materials in spinal surgery are critically analyzed.
自体骨移植常作为融合基质应用于后路颈椎稳定结构中。髂嵴骨常被使用，尽管供区并发症可能较为严重。肋骨虽易于获取、可扩展性强、具有独特的曲率且骨形态发生蛋白含量高，但很少被使用。作者对自体肋骨和髂嵴骨移植进行了比较分析，重点关注融合率和供区并发症。
回顾了600例行颈椎融合手术并使用自体骨移植患者的病历和X线片。300例患者进行了肋骨采集和后路颈椎融合。其余300例患者进行了髂嵴采集（248例用于前路颈椎融合，52例用于后路融合）。融合分析聚焦于后一组；通过评估整个组来确定供区并发症。融合标准包括骨小梁穿过供体-受体界面以及屈伸位X线片上的长期稳定性。移植并发症定义为任何因移植采集引起的不良事件。采用Fisher精确检验进行统计学比较。
两组获得的人口统计学数据具有可比性。肋骨结构放置在以下区域：枕颈区（196例患者）、寰枢椎区（35例患者）和下颈椎区（69例患者）。髂嵴移植放置在枕颈区（28例患者）、寰枢椎区（10例患者）和下颈椎区（14例患者）。300例肋骨移植结构中有296例（98.8%）发生融合，52例髂嵴移植结构中有49例（94.2%）发生融合（p = 0.056）。髂嵴的移植并发症高于肋骨（p < 0.00001）。肋骨移植的供区并发症为3.7%，包括肺炎（8例患者）、持续性肺不张（2例患者）和浅表伤口裂开（1例患者）。未发生气胸、肋间神经痛和慢性胸壁疼痛。25.3%的患者发生髂嵴并发症，包括慢性供区疼痛（52例患者）、伤口裂开（8例患者）、肺炎（7例患者）、感觉异常性股痛（4例患者）、需要引流的血肿（3例患者）和髂嵴骨折（2例患者）。即使不考虑慢性疼痛，获取髂嵴时遇到的并发症仍超过肋骨采集时遇到的并发症（p = 0.035）。在用于后路颈椎结构时，自体肋骨移植的融合率和供区并发症与髂嵴相比具有优势。据作者所知，这是迄今为止对脊柱手术中使用自体骨移植材料的安全性和有效性进行严格分析的最大系列研究。
