Section of Orthopaedic and Spinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Spine (Phila Pa 1976). 2012 Feb 1;37(3):E174-9. doi: 10.1097/BRS.0b013e3182269d64.
A prospective, comparative study.
We developed a hybrid graft (HBG) of porous β-tricalcium phosphate ceramics/percutaneously harvested bone sticks/autologous bone marrow aspirate for lumbar posterolateral fusion (PLF). The aim of this study was to investigate the efficacy of the HBG as a substitute for conventional corticocancellous iliac autografts.
Iliac crest bone graft (ICBG) has been traditionally used as the golden standard for lumbar spinal fusion. The significant complication rate associated with harvesting corticocancellous ICBG, however, has encouraged development of alternative graft substitutes.
From September 2005, 61 consecutive patients underwent decompressive laminotomy and 1-level instrumented PLF. Each patient in this study had the constructs of the HBG placed on 1 side of the intertransverse process gutter. An autologous local bone graft (LBG) harvested during decompressive laminotomy was placed on the other side as a control. Radiographic evaluation was performed at 6 months, 1 year after surgery, and subsequently on an annual basis. The fusion statuses on either side of vertebra were compared.
The flexion-extension motion in the dynamic x-rays at the target level decreased over time. Only 1 case exhibited over 5° of angular motion 2 years after surgery. In the evaluation of fusion status, the fusion rate for the HBG side (68.9% at 6 months, 83.6% at 1 year, 93.5% at 2 years) was higher than that for the LBG side (49.2% at 6 months, 75.4% at 1 year, 89.1% at 2 years) with a significant difference at 6 months after surgery. No significant complications at the donor site were found postoperatively.
The HBG promoted posterolateral spinal fusion without significant donor site morbidity. Because of its efficacy and safety, this hybrid construct seems promising as an alternative to conventional iliac bone grafts for lumbar spinal fusion.
前瞻性、对照研究。
我们开发了一种多孔 β-磷酸三钙陶瓷/经皮采集骨棒/自体骨髓抽吸物的杂交移植物（HBG），用于腰椎后侧融合（PLF）。本研究的目的是研究 HBG 作为传统皮质松质髂骨自体移植物替代品的效果。
髂嵴骨移植物（ICBG）一直被传统用作腰椎融合的金标准。然而，由于采集皮质松质 ICBG 而引起的重大并发症发生率，促使开发了替代移植物替代品。
自 2005 年 9 月起，连续 61 例患者接受减压椎板切除术和 1 级器械性 PLF。本研究中的每位患者在横突间沟的一侧放置 HBG 构建物。在减压椎板切除术期间采集的自体局部骨移植物（LBG）作为对照放置在另一侧。在术后 6 个月、1 年以及随后每年进行放射学评估。比较椎体两侧的融合状态。
在目标水平的动态 X 光片中，屈伸运动随时间而减少。仅 1 例在手术后 2 年出现超过 5°的角运动。在融合状态评估中，HBG 侧的融合率（6 个月时为 68.9%，1 年时为 83.6%，2 年时为 93.5%）高于 LBG 侧（6 个月时为 49.2%，1 年时为 75.4%，2 年时为 89.1%），术后 6 个月时差异有统计学意义。术后未发现供体部位有明显并发症。
HBG 促进了后侧脊柱融合，而没有明显的供体部位发病率。由于其有效性和安全性，这种杂交结构似乎有望成为腰椎融合的传统髂骨移植物的替代品。
