Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion: a prospective study with respect to bone union pattern
Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion: a prospective study with respect to bone union pattern
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DOI：
10.1007/s00586-003-0667-z
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发表时间：
2004-10-01
影响因子：
2.8
通讯作者：
Vanickova, E
中科院分区：
文献类型：
--
作者：
Suchomel, P;Barsa, P;Vanickova, E
背景。这项前瞻性半随机对照研究的目的是比较颈椎前路固定融合术中自体和异体骨移植物的融合率、融合过程以及塌陷和下沉的发生情况。研究了骨融合水平的数目和吸烟状况作为影响骨愈合过程的潜在因素。文献中尚未发现类似的关于颈椎前路椎间盘固定切除术和融合的前瞻性研究。79例患者连续使用Smith-Robinson技术，在一个或两个节段使用单一器械系统。76例植骨为尸状腓骨，37例植骨为自体髂骨。所有患者均随访至少2年。对随访期间获得的x线片进行分析，发现自体移植物和同种异体移植物的融合和塌陷率无统计学差异。同种异体移植物愈合时间明显延长。未见移植物迁移。一般情况下，融合和塌陷率在融合节段数量上没有差异，但两节段融合的愈合时间更长。当一级和二级亚组进行比较时，没有证据表明自体移植物和同种异体移植物在融合率或塌陷率方面有任何显著差异，同种异体移植物的愈合过程需要更长时间。吸烟状况不影响骨融合率或塌陷率，也不影响骨融合过程。本研究表明同种异体移植物是自体移植物在ACDF内的合适替代品。在同种异体骨移植中观察到的愈合时间延长似乎并不是器械手术的重要因素。在同种异体移植和自体移植亚群中，两节段移植并不意味着显著降低融合率，但与单节段固定手术相比，预期愈合时间更长。我们相对较少的患者数量可能不足以解释吸烟者和非吸烟者在融合率或过程上的显著差异，如先前报道的那样。
Background. The purpose of this prospective semi-randomised comparative study was to compare fusion rates, course of fusion, and occurrence of collapse and subsidence of autologous and allogenic bone grafts in instrumented anterior cervical fusion. The number of fused levels and the smoking status were investigated as potential factors influencing the bone-healing process. No similar prospective study on instrumented anterior cervical discectomy and fusion was found in the literature.Methods. Seventy-nine consecutive patients were operated on using the Smith-Robinson technique with a single instrumentation system at one or two levels. Seventy-six cadaverous fibular bone grafts and 37 autologous iliac-crest bone grafts were inserted. All patients were followed up for at least 2 years.Results. The radiographs obtained during the follow-up were analysed, and showed no statistical difference in fusion and collapse rate between autografts and allografts. Allografts showed significantly longer time to union. No case of graft migration was observed. No difference was found between fusion and collapse rate with respect to the number of fused levels in general, but greater time to union was seen in two-level fusions. When one- and two-level subgroups were compared, there was no evidence of any significant difference in fusion or collapse rates between autografts and allografts, and the healing process took longer in allogenic grafts. Smoking status did not alter any of the fusion or collapse rates, or the course of bone fusion.Conclusions. This study demonstrates that allografts are suitable substitutes for autografts in instrumented ACDF. Prolonged time to union observed in allogenic bone grafts does not seem to be an important factor in instrumented procedures. Two-level grafting does not imply a significantly lower fusion rate, but longer time to union can be expected than with single-level instrumented procedures in both allograft and autograft subgroups. Our relatively small number of patients may not have been sufficient to decipher significant differences between smokers and non-smokers in the rate or course of fusion as previously reported.