Rogozinski Abraham, Rogozinski Chaim, Cloud Gregory
Rogozinski Orthopedic Clinic, Jacksonville, Florida 32216, USA.
Orthopedics. 2009 Nov;32(11):809. doi: 10.3928/01477447-20090922-07.
Properly harvested iliac crest bone autograft applied to a meticulously prepared fusion bed produces a consistently high rate of fusion with a low incidence of donor site morbidity. Some reports advocate substituting bone morphogenic protein (BMP) for iliac crest bone autograft, but in posterolateral lumbar spinal fusion, BMP appears better suited to facilitate iliac crest bone autograft maturation than to substitute for it. In this single-center, nonrandomized, prospective study (minimum 2-year follow-up), cancellous-only iliac crest bone autograft was harvested for use in posterolateral lumbar spinal fusion. Reviewers blinded to graft condition and age assigned fusion scores to the random radiographs of 31 consecutive patients who underwent 1- to 3-level posterolateral lumbar spinal fusion using iliac crest bone autograft supplemented with either an implanted spinal fusion stimulator or BMP. There was no significant immediate or remote iliac crest bone autograft harvest morbidity, and there was a significant reduction in pain scores postoperatively (P<.001). At 12 months, BMP radiographs were more likely than spinal fusion stimulator radiographs to be rated as fused (P<.019). All BMP patients were deemed fused at 12 months and all spinal fusion stimulator patients at 24 months. In this study, iliac crest bone autograft supplemented with either BMP or spinal fusion stimulator resulted in a solid contiguous fusion without significant iliac crest bone autograft harvest-related morbidity. Bone morphogenic protein-supplemented iliac crest bone autograft fused at a faster rate, producing the more mature-appearing, trabeculated, robust fusion.
正确采集的髂嵴自体骨移植到精心准备的融合床，能产生持续的高融合率，且供区并发症发生率低。一些报告主张用骨形态发生蛋白（BMP）替代髂嵴自体骨移植，但在腰椎后外侧融合术中，BMP似乎更适合促进髂嵴自体骨移植成熟，而非替代它。在这项单中心、非随机、前瞻性研究（至少2年随访）中，采集单纯的松质髂嵴骨自体骨用于腰椎后外侧融合术。对移植物情况和年龄不知情的评估者，为31例连续患者的随机X光片评定融合分数，这些患者接受了1至3节段的腰椎后外侧融合术，使用了补充植入式脊柱融合刺激器或BMP的髂嵴骨自体骨。髂嵴骨自体骨采集后没有明显的近期或远期并发症，术后疼痛评分显著降低（P<0.001）。在12个月时，BMP组的X光片比脊柱融合刺激器组的X光片更有可能被评定为融合（P<0.019）。所有BMP组患者在12个月时被认为融合，所有脊柱融合刺激器组患者在24个月时被认为融合。在本研究中，补充BMP或脊柱融合刺激器的髂嵴骨自体骨均实现了坚实的连续融合，且没有与髂嵴骨自体骨采集相关的明显并发症。补充BMP的髂嵴骨自体骨融合速度更快，形成的融合更成熟，有小梁结构，更坚固。
