Sethi Paul M, Miranda Jose J, Kadiyala Sudha, Patel Tushar Ch, Panjabi Manohar, Troiano Nancy, Friedlaender Gary E
Orthopedic and Neurological Surgery Specialists, Greenwich, Connecticut, USA.
Am J Orthop (Belle Mead NJ). 2008 Apr;37(4):E84-90.
Data on the role of platelet concentrate (PC) in spinal fusion are limited. Using the New Zealand white rabbit model, we compared fusion rates at L5-L6 using 2 different volumes (1.5 cm(3), 3.0 cm(3)) of iliac crest autograft with and without PC (4 groups total, 10 animals in each). PC was collected from donor rabbits and adjusted to a concentration of 1 x 10(6) platelets/mL. Bone growth and fusion were evaluated using biomechanical, radiographic, and histologic testing. At 1.5 cm(3), autograft alone had a 29% fusion rate, compared with autograft plus PC, which had a 57% fusion rate (P = .06). At 3.0 cm(3), the fusion rate approached 90% in both groups. Radiologic fusion had a 70% correlation with biomechanical test results. Huo/Friedlaender scores were 4.3 (SD, 2.9) for 1.5-cm(3) autograft alone; 5.0 (SD, 3.5) for 1.5-cm(3) autograft plus PC; 4.7 (SD, 2.5) for 3.0-cm(3) autograft alone; and 7.7 (SD, 0.6) for 3.0-cm(3) autograft plus PC. For 1.5-cm(3) autograft, a trend toward improvement in biomechanically defined fusion was found when PC was added, which suggests that, when the amount of bone graft is limited, PC may function as a graft extender in posterolateral fusion. At higher volumes of bone graft, no appreciable difference was noted between groups. Although radiography revealed fusion masses, the technique was not useful in identifying pseudarthrosis. On histologic analysis, adding PC seemed to result in more mature bone at both volumes, with the most mature bone in the group with 3.0-cm(3) autograft plus PC.
关于血小板浓缩物（PC）在脊柱融合中作用的数据有限。我们使用新西兰白兔模型，比较了在L5-L6节段使用2种不同体积（1.5立方厘米、3.0立方厘米）的髂嵴自体骨，分别添加和不添加PC（共4组，每组10只动物）时的融合率。PC从供体兔采集并调整至浓度为1×10⁶个血小板/毫升。通过生物力学、影像学和组织学检测评估骨生长和融合情况。在1.5立方厘米组，单纯自体骨的融合率为29%，而自体骨加PC组的融合率为57%（P = 0.06）。在3.0立方厘米组，两组的融合率均接近90%。影像学融合与生物力学测试结果的相关性为70%。单纯1.5立方厘米自体骨的霍/弗里德兰德评分为4.3（标准差，2.9）；1.5立方厘米自体骨加PC组为5.0（标准差，3.5）；单纯3.0立方厘米自体骨组为4.7（标准差，2.5）；3.0立方厘米自体骨加PC组为7.7（标准差，0.6）。对于1.5立方厘米的自体骨，添加PC后在生物力学定义的融合方面有改善趋势，这表明当骨移植量有限时，PC可能在后外侧融合中起到移植增强剂的作用。在骨移植量较高时，两组之间未观察到明显差异。尽管影像学显示有融合块，但该技术在识别假关节方面并无用处。组织学分析显示，添加PC似乎在两种体积下都能导致更成熟的骨，最成熟的骨出现在3.0立方厘米自体骨加PC组。
