Vaccaro Alexander R, Chiba Kazuhiro, Heller John G, Patel Tushar Ch, Thalgott John S, Truumees Eeric, Fischgrund Jeffrey S, Craig Matthew R, Berta Scott C, Wang Jeffrey C
Department of Orthopedics, Thomas Jefferson University Hospital, Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
Spine J. 2002 May-Jun;2(3):206-15. doi: 10.1016/s1529-9430(02)00180-8.
Bone grafting is used to augment bone healing and provide stability after spinal surgery. Autologous bone graft is limited in quantity and unfortunately associated with increased surgical time and donor-site morbidity. Alternatives to bone grafting in spinal surgery include the use of allografts, osteoinductive growth factors such as bone morphogenetic proteins and various synthetic osteoconductive carriers.
Recent research has provided insight into methods that may modulate the bone healing process at the cellular level in addition to reversing the effects of symptomatic disc degeneration, which is a potentially disabling condition, managed frequently with various fusion procedures. With many adjuncts and alternatives available for use in spinal surgery, a concise review of the current bone grafting alternatives in spinal surgery is necessary.
STUDY DESIGN/SETTING: A systematic review of the contemporary English literature on bone grafting in spinal surgery, including abstract information presented at national meetings.
Bone grafting alternatives were reviewed as to their efficacy in extending or replacing autologous bone graft sources in spinal applications.
Alternatives to autologous bone graft include allograft bone, demineralized bone matrix, recombinant growth factors and synthetic implants. Each of these alternatives could possibly be combined with autologous bone marrow or various growth factors. Although none of the presently available substitutes provides all three of the fundamental properties of autograft bone (osteogenicity, osteoconductivity and osteoinductivity), there are a number of situations in which they have proven clinically useful.
Alternatives to autogenous bone grafting find their greatest appeal when autograft bone is limited in supply or when acceptable rates of fusion may be achieved with these substitutes (or extenders) despite the absence of one or more of the properties of autologous bone graft. In these clinical situations, the morbidity of autograft harvest is reasonably avoided. Future research may discover that combinations of materials may cumulatively result in the expression of osteogenesis, osteoinductivity and osteoconductivity found in autogenous sources.
骨移植用于促进脊柱手术后的骨愈合并提供稳定性。自体骨移植数量有限，且遗憾的是会增加手术时间和供区并发症。脊柱手术中骨移植的替代方法包括使用同种异体骨、骨形态发生蛋白等骨诱导生长因子以及各种合成骨传导载体。
近期研究除了揭示可逆转症状性椎间盘退变（一种常通过各种融合手术治疗的潜在致残性疾病）的影响外，还深入探讨了可能在细胞水平调节骨愈合过程的方法。鉴于脊柱手术中有许多辅助手段和替代方法可供使用，因此有必要对当前脊柱手术中骨移植的替代方法进行简要综述。
研究设计/场所：对当代关于脊柱手术中骨移植的英文文献进行系统综述，包括在全国会议上发表的摘要信息。
对骨移植替代方法在脊柱应用中扩展或替代自体骨移植来源的疗效进行综述。
自体骨移植的替代方法包括同种异体骨、脱矿骨基质、重组生长因子和合成植入物。这些替代方法中的每一种都可能与自体骨髓或各种生长因子联合使用。尽管目前可用的替代物均未具备自体骨的所有三种基本特性（成骨性、骨传导性和骨诱导性），但在许多情况下它们已被证明具有临床实用性。
当自体骨供应有限或尽管这些替代物（或补充物）缺乏自体骨移植的一种或多种特性，但仍能实现可接受的融合率时，自体骨移植的替代方法具有最大吸引力。在这些临床情况下，可合理避免自体骨采集的并发症。未来的研究可能会发现，材料组合可能会累积导致自体来源中发现的成骨、骨诱导和骨传导表达。
