重组人骨形态发生蛋白-2联合局部骨移植替代髂嵴骨移植用于腰椎后外侧融合术。
Use of recombinant human bone morphogenetic protein-2 with local bone graft instead of iliac crest bone graft in posterolateral lumbar spine arthrodesis.
作者信息
Park Daniel K, Kim Sung S, Thakur Nikhil, Boden Scott D
机构信息
*William Beuamont Hospital Department of Orthopedic Surgery Lahser Road Southfield, MI †Seoul Spine Institute Inje University Sanggye-Paik Hospital, Dongil-ro Nowon-gu, Seoul Korea ‡Upstate Bone and Joint Center Upstate Medical University-SUNY Syracuse, NY; and §Emory University, Executive Park, South Atlanta, GA.
出版信息
Spine (Phila Pa 1976). 2013 May 20;38(12):E738-47. doi: 10.1097/BRS.0b013e31828fd23c.
STUDY DESIGN
Prospective clinical study.
OBJECTIVE
Compare fusion rates between recombinant human bone morphogenetic protein-2 (rhBMP-2) and iliac crest bone graft (ICBG) with rhBMP-2 and local bone graft (LBG) (±bone graft extenders) in posterolateral fusion.
SUMMARY OF BACKGROUND DATA
Previous reports have shown higher fusion rates when adding rhBMP-2 to ICBG in lumbar posterolateral fusion, compared with ICBG alone. We compared the fusion success rates between rhBMP-2 delivered with ICBG versus that with LBG.
METHODS
Fusion rates were compared in patients with degenerative spondylolisthesis (1-2 levels) with accompanying lumbar stenosis. RhBMP-2 (INFUSE, Medtronic) was delivered on an absorbable collagen sponge (6 mg/side at 1.5 mg/mL) with ICBG alone or with LBG wrapped inside the sponge. Thin slice computed tomographic scans were assessed at 6, 12, and 24 months.
RESULTS
In a consecutive series, 16 patients (30 levels) received ICBG with rhBMP-2 and 35 patients (49 levels) received LBG with rhBMP-2. For the ICBG cohort, 80.0%, 93.4%, 96.7% of levels were fused at 6, 12, and 24 months. In contrast, for the local bone with rhBMP-2 cohort, 87.7%, 98.0%, and 98.0% were fused at 6, 12, and 24 months. There was no statistically significant difference in fusion success rates between the 2 groups at any time point. As for fusion quality, the fusion mass showed superior quality in ICBG group than in the local bone group at each time point.
CONCLUSION
This study validates the high fusion success rates previously reported by adding rhBMP-2 to ICBG and shows that local bone may be safely substituted for ICBG in 1- to 2-level posterolateral fusion. The fusion rates were comparable. The avoidance of ICBG harvest has implications for operative time, blood loss, and morbidity. Lastly, this is the first study that directly compares the fusion success rate and quality using local bone with rhBMP-2 versus ICBG with rhBMP-2 at various times.
LEVEL OF EVIDENCE
研究设计
前瞻性临床研究。
目的
比较重组人骨形态发生蛋白-2（rhBMP-2）与髂嵴骨移植（ICBG）联合rhBMP-2与局部骨移植（LBG）（±骨移植增强材料）在后外侧融合中的融合率。
背景资料总结
既往报道显示，在腰椎后外侧融合中，与单纯ICBG相比，ICBG添加rhBMP-2时融合率更高。我们比较了ICBG联合rhBMP-2与LBG联合rhBMP-2的融合成功率。
方法
比较伴有腰椎管狭窄的退行性腰椎滑脱（1-2个节段）患者的融合率。将rhBMP-2（INFUSE，美敦力公司）置于可吸收胶原海绵上（每侧6mg，浓度1.5mg/mL），单独与ICBG联合使用，或与包裹在海绵内的LBG联合使用。在6、12和24个月时进行薄层计算机断层扫描评估。
结果
在一个连续系列研究中，16例患者（30个节段）接受了ICBG联合rhBMP-2治疗，35例患者（49个节段）接受了LBG联合rhBMP-2治疗。对于ICBG组，在6、12和24个月时，分别有80.0%、93.4%和96.7%的节段实现融合。相比之下，对于LBG联合rhBMP-2组，在6、12和24个月时，融合率分别为87.7%、98.0%和98.0%。两组在任何时间点的融合成功率均无统计学显著差异。至于融合质量，在每个时间点，ICBG组的融合块质量均优于局部骨组。
结论
本研究验证了既往报道的ICBG添加rhBMP-2的高融合成功率，并表明在1-至2节段后外侧融合中，局部骨可安全替代ICBG。融合率相当。避免采集ICBG对手术时间、失血量和发病率均有影响。最后，这是第一项直接比较不同时间点LBG联合rhBMP-2与ICBG联合rhBMP-2的融合成功率和质量的研究。
证据级别
4级。
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