▪ Anterior Cervical Discectomy and Fusion Using a Porous Hydroxyapatite Bone Graft Substitute
▪ Anterior Cervical Discectomy and Fusion Using a Porous Hydroxyapatite Bone Graft Substitute
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▪ 使用多孔羟基磷灰石骨移植替代物进行前路颈椎间盘切除术和融合术
DOI：
10.1097/00007632-199410150-00017
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发表时间：
1994
期刊：
影响因子：
3
通讯作者：
R. Mccabe
中科院分区：
文献类型：
--
作者：
T. Zdeblick;M. Cooke;D. Kunz;David Wilson;R. Mccabe
目标.本研究分析了珊瑚羟基磷灰石骨替代物在ACDF中的使用，包括颈椎前路钢板和未使用颈椎前路钢板。研究设计.使用山羊模型测试多节段颈椎前路融合的愈合情况。与组织学、影像学和生物力学试验数据进行比较。方法.对49只成年高山山羊进行了三节段前路椎间盘切除术。使用了7个治疗组，每组7只山羊; I组无融合，IIa组采用三皮质髂嵴自体移植物，IIb组采用自体移植物加前路钢板，伊利亚组采用三皮质髂嵴新鲜冷冻同种异体移植物，IIIb组采用同种异体移植物加前路钢板，IVa组采用多孔羟基磷灰石矩形植入物，IVb组采用ProOsteon 500植入物加颈椎前路钢板。结果在组织学上，12周时，48%的ProOsteon（Interpore，Irvine，CA）植入物被评定为结合，10%具有纤维间隙，29%塌陷，14%挤出。颈椎前路钢板固定改善了结果，71%的植入物表现出良好的结合，24%的植入物塌陷，5%的植入物存在纤维间隙。这些组织学结果与自体骨相比是有利的，并且优于同种异体骨。荧光染料分析显示，没有种植体与宿主骨完全转换，但在12周时，所有种植体均具有外周蠕变替代，并有新骨形成的切割锥。生物力学方面，使用ProOsteon植入物的脊柱扭转刚度低于自体移植物，但刚度与同种异体移植物相同。ProOsteon植入物组中的肱骨-伸展中立区刚度低于同种异体移植物或自体移植物。结论.使用珊瑚基羟基磷灰石骨移植替代物进行颈椎前路融合导致12周时植入物塌陷率显著，但显示出良好的生物相容性，植入物被宿主骨早期蠕变替代。同时使用颈椎前路钢板和植入物可防止挤出。
Objectives. This study analyzed the use of a coral hydroxyapatite bone substitute for use in ACDF both with and without an anterior cervical plate. Study Design. The healing of multilevel anterior cervical fusions was tested using a goat model. Comparisons were drawn with histologic, radiographic, and bio‐mechanical test data. Methods. Forty‐nine mature alpine goats had three‐level anterior discectomies performed. Seven treatment groups of seven goats each were used; Group I with no fusion, Group IIa having tricortical iliac crest autograft, Group IIb having autograft plus an anterior plate, Group Ilia having tricortical iliac crest fresh‐frozen allograft, Group IIIb having allograft plus an anterior plate, Group IVa having rectangular‐shaped implants of porous hydroxyapatite, and Group IVb having ProOsteon 500 implants with an anterior cervical plate. Results. Histologically, at 12 weeks 48% of the ProOsteon (Interpore, Irvine, CA) implants were rated as incorporated, 10% as possessing a fibrous gap, 29% as collapsed, and 14% as extruded. Anterior cervical plating improved the results with 71% of the implants showing good incorporation, 24% with collapse, and 5% with a fibrous gap. These histologic results compare favorably with autogenous bone and are improved over allograft bone. Fluorochrome analysis showed that none of the implants had complete turnover with host bone, but that all possessed peripheral creeping substitution with cutting cones of new bone formation at 12 weeks. Biomechanically, the spines using the ProOsteon implant were less stiff in torsion than autograft, but equal in stiffness to allograft. Flexion‐extension neutral zone stiffness was lower in the ProOsteon implant group than either allograft or autograft. Conclusions. The use of a coral‐based hydroxyapatite bone graft substitute for anterior cervical fusions led to significant rates of implant collapse at 12 weeks but showed excellent biologic compatibility with good early creeping substitution of the implant by host bone. The concomitant use of an anterior cervical plate with the implant prevents extrusion.