Kitchel Scott H
Oregon Health & Sciences University, 3181 SW Sam Jackson Park Road, Portland, 97201, USA.
Spine J. 2006 Jul-Aug;6(4):405-11; discussion 411-2. doi: 10.1016/j.spinee.2005.09.013.
Multiple bone graft substitutes for spinal fusion have been studied with varying results.
The purpose of this study was to assess the effectiveness of a mineralized collagen matrix combined with bone marrow, versus autologous bone, in the same patients undergoing a posterior lumbar interbody fusion and an instrumented posterolateral lumbar fusion.
STUDY DESIGN/SETTING: A prospective, comparative study.
Patients indicated for one-level posterior lumbar interbody fusion and instrumented posterolateral lumbar fusion, serving as self-controls.
Thin-cut computed tomographic scans with sagittal reconstruction and plain radiographs, including lateral flexion/extension views were performed and assessed at 12 and 24 months after surgery. Oswestry Disability Index and Visual Analog Scale questionnaires were completed by all patients preoperatively and at 12 and 24 months after surgery.
After informed consent and failure of nonoperative treatment, 25 consecutive patients requiring one-level instrumented posterolateral fusion combined with posterior interbody fusion were enrolled in the study. Mineralized collagen bone graft substitute combined with bone marrow aspirate was used on one side of the posterolateral fusion, with iliac crest autograft on the contralateral side.
A fusion rate of 84% (21/25) was achieved for the autologous bone grafts and 80% (20/25) for the bone graft substitute. The interbody fusion rate was 92% (23/25). Mean Oswestry Disability Index (ODI) scores decreased 57.2% at 12 months and 55.6% at 24 months, compared with baseline.
Mineralized collagen bone graft substitute exhibited similar radiographic results compared with autograft in this model. Further trials incorporating bilateral fusion, as well as posterolateral fusion alone without interbody fusion are warranted to confirm the results of this study.
多种用于脊柱融合的骨移植替代物已被研究，结果各异。
本研究旨在评估在同一组接受后路腰椎椎间融合术和器械辅助下腰椎后外侧融合术的患者中，矿化胶原基质联合骨髓与自体骨相比的有效性。
研究设计/地点：一项前瞻性比较研究。
适用于单节段后路腰椎椎间融合术和器械辅助下腰椎后外侧融合术的患者，作为自身对照。
术后12个月和24个月进行带有矢状面重建的薄层计算机断层扫描和X线平片检查，包括侧屈/后伸位片，并进行评估。所有患者在术前以及术后12个月和24个月完成Oswestry功能障碍指数和视觉模拟量表问卷调查。
在获得知情同意且非手术治疗失败后，连续纳入25例需要单节段器械辅助下后外侧融合联合后路椎间融合的患者。在后外侧融合的一侧使用矿化胶原骨移植替代物联合骨髓抽吸物，对侧使用自体髂骨移植。
自体骨移植的融合率为84%（21/25），骨移植替代物的融合率为80%（20/25）。椎间融合率为92%（23/25）。与基线相比，平均Oswestry功能障碍指数（ODI）评分在术后12个月下降了57.2%，在术后24个月下降了55.6%。
在该模型中，矿化胶原骨移植替代物与自体移植相比显示出相似的影像学结果。有必要进行进一步试验，包括双侧融合以及单独的后外侧融合而不进行椎间融合，以证实本研究结果。
