儿童颅颈交界融合术自体肋骨结构性植骨△

Autologous rib structural bone graft in instrumented fusion of craniocervical junction area in children

摘要:

[目的]介绍儿童颅颈交界区后路固定融合手术中自体肋骨结构性植骨的手术技术和初步临床效果。[方法]对 2 例颅颈交界区疾患的儿童患者实施寰枢椎/枕颈后路植骨融合内固定+取肋骨术。行颈后路正中切口，常规置入寰枢椎钉-棒/枕颈板-钉-棒系统内固定，高速磨钻于寰椎后弓/枕骨后下缘及枢椎椎板上缘打磨植骨槽，然后于后胸壁肩胛下角下沿肋骨方向斜切口，取合适长度肋骨修整后，卡入寰椎后弓/枕骨后下缘与枢椎椎板植骨槽之间进行结构性植骨。[结果]2 例患者手术过程顺利，未出现血气胸。术后未出现肋骨取骨区并发症，2 例患者术后症状明显改善，术后 JOA 和 VAS 评分均显著改善。术后 3 个月随访复查 CT 见植骨已融合，肋骨取骨处已膜内成骨重建。[结论]儿童颅颈交界区后路固定融合手术中，自体肋骨结构性植骨是一种安全且有效的植骨方式。

关键词:颅颈交界区;后路固定融合术;肋骨;自体骨移植

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of autologous rib structural bone grafting in instrumented fusion of craniocervical junction zone in children. [Methods] Two children received atlantoaxial, or occipitocervical instru- mented fusion with rib autografts for congenital craniocervical junction disorders. A posterior cervical median incision was made, and the at- lantoaxial pedicle screw-rod, or occipitocervical plate-screw-rod system was routinely placed for internal fixation. A high-speed burr was used to grind the bone graft groove at the posterior inferior edge of the atlantoaxial arch, or occipital and the superior edge of the cardinal ver- tebral plate. Then, an oblique incision was made along the direction of the ribs under the subscapular angle of the posterior chest wall to ex- pose the rib, a rib segment was harvested and trimmed into columns in proper length, and placed on the bone bed on the craniocervical junc- tion zone. [Results] The surgical procedure was successfully performed in both patients, without hemopneumothorax and postoperative com- plications in the rib donor site, and were followed up for 6 months and 12 months, respectively. Both patients got significantly symptom im- provement postoperatively in terms of JOA and VAS scores. Solid atlantoaxial or craniocervical fusion was noted with bony rib healing in the donor site 3 months postoperatively. [Conclusion] The autologous rib structural bone grafting is a safe and effective instrumented fusion of the craniocervical junction area in children.

Key words:craniocervical junction area; posterior instrumented fusion; rib; bone autograft