Cengiz ÇOKLUK, Mustafa ARAS, Alparslan ŞENEL, Ömer İYİGÜN, ARİF ÖNDER, Cemil RAKUNT, Fahrettin ÇELİK

Tek seviye Cloward füzyon yapılan alt servikal travmalı olgularda otogreft ve allogreft uıygulamasının karşılaştırılması

Kliniğimizde Ocak 1997- Aralık 2001 tarihleri arasında servikal travma nedeniyle otogreft ve allogreft (Tutoplast) kullanılarak tek seviye Cioward füzyon yapılan 52 (18 kadın, 34 erkek) olgu retrospektif olarak yeniden incelendi. 28 (%54) olguda iliak kanattan elde edilen otogreft, kalan 24 (%46) olguda ise insan patella orjinli allogreft kullanıldı. Olgular ortalama 6 ay takip edilerek sonuçlar direkt X-ray ve nörolojik muayene ile değerlendirildi. Otolog kemik greft kullanılan olguların %78'inde normal lordoz korunurken, bu oran allogreft kullanılan olgularda %55 olarak bulundu. İleri angülasyon nedeniyle tekrar ameliyat edilen olgu sayısı otogreft kullanılan olgularda %4, allogreft kullanılan olgularda ise %8 olarak bulundu. 52 olguyu kapsayan serimizin sonuçlarının değerlendirilmesinde postoperatif servikal lordo-zun korunması yönünden, otogreft kullanılan olguların radyolojik sonuçları allogreft kullanılan olgularınkinden daha başarılı .olarak bulundu. İki grup arasındaki fark istatistiksel olarak anlamlıdır (p

Anahtar Kelimeler:

Omurilik yaralanmaları, Servikal omurga, Geriyedönük çalışma, Nakil, otolog, Nakil, homolog, Cerrahi işlemler, operatif

The comparison of autograft and allograft interbody fusion in the platients operated by using Cloward fusion technique for cervical trauma

The neuroradiological data of 52 operated cases (18 female, 34 male) by using otograft and allograft Cloward fusion technique for traumatic cervical fracture was retrospectively investigated in the determination of postoperative clinical and neuroradiological success. In 28 (54%) cases, otograft harvested from iliac bone was used for graft material and remaining 24 (46%) cases were operated with allograft. The patients had been followed up for 6 months with periodical neurological examination and direct cervical X-ray. Normal cervical lordosis was found in 78% of the patient with autograft but 55% of patients with allograft. Reoperation rate for severe angulation was found in 4% of the patient with autograft and in 8% of patient with allograft. In conclusion; the postoperative neuroradiological results of autograft fusion in the patient with cervical trauma are seems to be more successful from those of patient operated by using allograft interbody fusion. The differences between these two group were statistically significant (p<0.05). Autolog bone graft harvested from iliac bone is cost-effective and safe material, and can be use for the patients with cervical trauma.

Keywords:

Spinal Cord Injuries, Cervical Vertebrae, Retrospective Studies, Transplantation, Autologous, Transplantation, Homologous, Surgical Procedures, Operative,

___

1. Bishop RC, Moore KA, Hadley MN. Anterior cervical interbody fusion using autogeneic and allogeneic bo¬ne graft substrate: a prospective comparative analy¬sis. J Neurosurg 1996; 85: 206-210. %. Cloward R. The anterior approach for removal of rup¬tured cervical disc. J Neurosurg 1958; 15: 602-617.

3. Cloward RB .'Complications of anterior cervical disc operation and their treatment. Surgery 1971; 69: 175-182. 4. Frothingham RE, Solomon A. The use of allografts in anterior cervical interbody fusion.J Miss State Med Assoc 1988; 29: 71-74. 5. Heiple KG, Chase SW, Herndon CD. A comparative study of the healing process following different types of bone transplantation. J Bone Joint Surg (Am) 1963; 45: 1593-1616. 6. Horsey WJ, Tucker WS, Hudson AR, et all. Experien¬ ce with early anterior operation in acute injuries of the cervical spine. Paraplegia 1977; 15: 110-122. 7. Jastrzebski T, Borowicz A, Jazienicki M .The treat¬ ment of vertebral cervical dislocation by the Cloward's method. Ann Univ Mariae Curie Sklodowska [Med] 1994; 49: 83-6. 8. Malca SA, Roche PH, Rosset E, et al. Cervical inter¬ body xenograft with plate fixation. Evaluation of Fusion after 7 years of use in post-traumatic dis- coligamentous insitability. Spine 1996; 21: 685-690. 9. McCulloch JA, Young PH. Bone grafting in the degen¬ erative spine. İn Essentials of spinal microsurgery, edited by McCulloch JA, Young PH 1998, Lippincott- Raven Publishers, Philadelphia pp 55-68.

10. Moussa AH, Nitta M, Symon L.The results of anterior cervical fusion in cervical spojidylosis. Review of 125 cases. Acta Neurochir (Wien) 1983; 68: 277-288. 11. Otero Vich JM.Update on the Cloward procedure: new instruments. J Neurosurg 1:994; 81: 216-720. 12. Probst C. Karli HU. Traumatic dislocations/dis¬ location fractures of the cervical spine. Neurosurgical experiences in 42 surgical patients Aktüelle Traumatol 1989; 19: 47-56. 13. Savolainen S, Usenius JP, HernesniemiJ. Iliac crest versus artificial bone grafts in 250 cervical fusions. Acta Neurochirurgica 1994; 129: 54-57. 14. Tunturi T, Leikkonen O, Paakkala T, et al. Cloward's anterior fusion in the treatment/of cervical spinal traumatic injury and degeneration. Arch Orthop Trauma Surg 1979; 94: 1-9. 15. Zeilinger FS, Meier U, Klotzer R. Fractures of the lower cervical spine. Surgical methods and long-term outcome Unfallchirurgie 1998; 24: 3-9. 16. ZdeblickTA, DuckerTB. The use of freeze-dried allog- raft bone for anterior cervical fusions. Spine 1991; 16: 726-729.