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Free Fibula Flap for Restoration of Spinal Stability after Oncologic Vertebrectomy Is Predictive of Bony Union.

游离腓骨瓣用于肿瘤椎体切除术后恢复脊柱稳定性可预测骨性愈合。

  • 影响因子:1.74
  • DOI:10.1097/PRS.0000000000006382
  • 作者列表:"Mericli AF","Boukovalas S","Rhines LD","Adelman DM","Hanasono MM","Chang EI
  • 发表时间:2020-01-01
Abstract

BACKGROUND:Nonvascular bone grafts larger than 4 cm have a 50 percent nonunion rate in spine surgery. Vascular bone flaps are one potential solution; however, their utility in spine surgery has not been fully elucidated. The authors hypothesized that the addition of a free fibula flap after oncologic vertebrectomy would safely potentiate bone union. METHODS:The authors performed a retrospective analysis, including all patients who underwent oncologic vertebrectomy for a primary bone tumor at their institution from 2002 to 2017. Patients were divided into two groups: those who underwent spinal reconstruction with nonvascularized bone graft and an alloplastic cage (control) and those whose reconstruction was augmented with a free fibula flap. RESULTS:Forty patients were included (free fibula flap, n = 16; control, n = 24). Adjuvant therapies and medical comorbidities were similar between the two groups. Chordoma was the most common abnormality in both groups. The median number of vertebrae resected in the free fibula flap group was two, compared to one in the cage group (p = 0.08). Despite the smaller mean resection size, there were significantly more nonunions (41.7 percent versus 6.3 percent; p = 0.02), instrumentation complications (33.3 percent versus 6.3 percent; p = 0.04), and neurologic complications (25 percent versus 0 percent; p = 0.03) in the control group. Multivariate logistic regression revealed a control reconstruction significantly predictive of nonunion (OR, 57.04; 95 percent CI, 1.17 to 2773; p = 0.04). Free fibula flap patients demonstrated evidence of bony union at a mean of 4.8 months versus 22.4 months in the control group (p < 0.001). CONCLUSIONS:Free fibula flap surgery in spinal reconstruction after oncologic vertebrectomy is safe and effective. Free fibula flap surgery is independently protective against nonunion and is associated with more rapid union compared with the control. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III.

摘要

背景: 在脊柱外科手术中,大于 4 cm的非血管骨移植物有 50% 的骨不连率。血管骨瓣是一种潜在的解决方案; 然而,它们在脊柱手术中的效用尚未完全阐明。作者假设在肿瘤椎体切除术后增加游离腓骨瓣可安全地加强骨愈合。 方法: 作者进行了回顾性分析,包括 2002 年至 2017 年在其机构接受原发性骨肿瘤椎体切除术的所有患者。将患者分为两组: 采用非血管化骨移植和成体笼 (对照) 进行脊柱重建的患者和采用游离腓骨瓣增强重建的患者。 结果: 共纳入 40 例患者 (游离腓骨瓣,n = 16; 对照,n = 24)。两组的辅助治疗和内科合并症相似。脊索瘤是两组中最常见的异常。游离腓骨瓣组切除的椎体中位数为 2 个,而cage组为 1 个 (p = 0.08)。尽管平均切除大小较小,但骨不连明显较多 (41.7% 对 6.3%; p = 0。0 2) 、器械并发症 (33.3% 对 6.3%; p = 0。0 4),和神经系统并发症发生率 (25% vs 0; p = 0.0 3) 在对照组中。多变量logistic回归显示对照重建显著预测骨不连 (OR,57.04; 95% CI,1.17 ~ 2773; p = 0.04)。游离腓骨瓣患者在平均 4.8 个月时表现出骨性愈合的证据,而对照组为 22.4 个月 (p <0.001)。 结论: 游离腓骨瓣在脊柱肿瘤椎体切除术后重建中的应用是安全有效的。游离腓骨瓣手术独立预防骨不连,与对照相比愈合更快。 临床问题/证据水平: 治疗性,III。

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发表时间:2020-03-01
DOI:10.1177/1078155219842277
作者列表:["Gyori DJ","Bullington SM","Crawford BS","Vernon VP"]

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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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