Moro-Barrero Luis, Acebal-Cortina Gonzalo, Suárez-Suárez Miguel, Pérez-Redondo Julio, Murcia-Mazón Antonio, López-Muñiz Alfonso
Orthopaedic Surgery Department, Cabueñes-Gijón Hospital, Spain.
J Spinal Disord Tech. 2007 Aug;20(6):409-15. doi: 10.1097/bsd.0b013e318030ca1e.
To determine whether a biphasic calcium phosphate (BCP) ceramic supplemented with fresh autologous bone marrow (BMA) can give rise to adequate bone to achieve a vertebral fusion mass.
A prospective nonrandomized, radiographic study on 35 patients with posterolateral fusion using rigid transpedicular instrumentation for degenerative lumbar disease. At least 2-year follow-up. On the left side: autologous bone graft obtained from decompression. On the right side: a mixture of BCP and fresh autogenous bone marrow from the right iliac crest. Single-level fusion in 22 patients and two or more levels in 13. Patients assessed with x-rays and computed tomography by an orthopedic surgeon and an independent radiologist. Fusion mass was considered "good" when there was a continuous block of bone without radiolucent areas. No intersegmental bony bridging fusion was considered "poor" mass. McNemar, Fisher, and kappa tests were used for statistical analysis.
The interobserver agreement (kappa) had an average of 0.75 for the fusion masses. The interobserver average in the radiologic evaluation of ceramic resorption was 0.68. No differences between smokers and nonsmokers were found. Plain radiography findings: good left fusion masses (autologous bone) in 31 patients and poor in 4; good right masses (BMA plus BCP) in 31 patients and poor in 4 (P > 0.05). Computed tomography evaluation: good left fusion masses in 28 patients and poor in 7; good right fusion masses in 31 patients and poor in 4 (P > 0.05). One patient was reoperated, allowing biopsies to be performed: compact bone tissue was observed around hydroxyapatite in the right fusion mass.
The differences detected between right-side and left-side masses are not statistically significant. This indicates that, BMA and BCP, when mixed, behave like composite grafts and are able to generate sufficient bone mass for arthrodesis when a rigid instrumentation is used. However, a larger number of cases and longer follow-up are needed to generalize the indication.
确定补充新鲜自体骨髓（BMA）的双相磷酸钙（BCP）陶瓷能否产生足够的骨量以实现椎体融合块。
对35例因退行性腰椎疾病采用刚性经椎弓根器械进行后外侧融合的患者进行前瞻性非随机影像学研究。至少随访2年。左侧：取自减压部位的自体骨移植。右侧：BCP与右侧髂嵴新鲜自体骨髓的混合物。22例患者为单节段融合，13例为两个或更多节段融合。由骨科医生和独立放射科医生通过X线和计算机断层扫描对患者进行评估。当存在连续的骨块且无透亮区时，融合块被认为“良好”。无节段间骨桥接融合被认为是“差”的融合块。采用McNemar检验、Fisher检验和kappa检验进行统计分析。
观察者间对融合块的一致性（kappa）平均为0.75。观察者间对陶瓷吸收的放射学评估平均为0.68。未发现吸烟者和非吸烟者之间存在差异。X线平片结果：31例患者左侧融合块良好（自体骨），4例不佳；31例患者右侧融合块良好（BMA加BCP），4例不佳（P>0.05）。计算机断层扫描评估：28例患者左侧融合块良好，7例不佳；31例患者右侧融合块良好，4例不佳（P>0.05）。1例患者再次手术，进行了活检：在右侧融合块的羟基磷灰石周围观察到致密骨组织。
右侧和左侧融合块之间检测到的差异无统计学意义。这表明，BMA和BCP混合时，表现为复合移植，当使用刚性器械时，能够产生足够的骨量用于关节融合。然而，需要更多病例和更长时间的随访来推广该适应证。
