Department of Orthopaedics and Traumatology, Hospital Znojmo, MUDr. Jana Jánského 11, Znojmo, 669 02, Czech Republic; Department of Traumatologic Surgery, University of Masaryk at Brno, Faculty of Medicine, Ponávka 6, Brno, 602 00, Czech Republic.
Department of Orthopaedics and Traumatology, Hospital Znojmo, MUDr. Jana Jánského 11, Znojmo, 669 02, Czech Republic; Department of Traumatologic Surgery, University of Masaryk at Brno, Faculty of Medicine, Ponávka 6, Brno, 602 00, Czech Republic.
Spine J. 2014 Jul 1;14(7):1318-24. doi: 10.1016/j.spinee.2013.12.014. Epub 2013 Dec 20.
Spondylodesis in the operative management of lumbar spine diseases has been the subject of numerous studies over several decades. The posterolateral fusion (PLF) with pedicle screw fixation is a commonly used procedure.
To determine whether the addition of bone marrow concentrate (BMC) to allograft bone increases fusion rate after instrumented posterior lumbar fusion.
The study was prospective, randomized, controlled, and blinded.
Eighty patients with degenerative disease of the lumbar spine underwent instrumented lumbar or lumbosacral PLF (22 men, 58 women; body mass index less than 35 for a good visualization of the PLF in the X-rays). In 40 cases, the PLF was done with spongious allograft chips alone (Group I, age 62.7 years in average, range 47-77 years, level of fusion 1-2). In another 40 cases, spongious allograft chips were mixed with BMC (Group II, age 58.5 years in average, range 42-80, level of fusion 1-3), including the mesenchymal stem cells (MSCs). Patients were scheduled for anteroposterior and lateral radiographs 12 and 24 months after the surgery and for computed tomography scanning 24 months after the surgery. Fusion status and the degree of mineralization of the fusion mass were evaluated separately by two radiologists blinded to patient group affiliation. The bony mass was judged as fused if there was uninterrupted bridging of well-mineralized bone between the transverse processes or sacrum, with trabeculation indicating bone maturation on least at one side of the spines.
In Group I at 12 months, the bone graft mass was assessed in X-rays as fused in no cases (0%) and at 24 months in four cases (10%). In Group II, 6 cases (15%) achieved fusion at 12 months and 14 cases (35%) at 24 months. The statistically significant difference between both groups was proven for complete fusion at both 12 (p=.041) and 24 months (p=.011). Computed tomography scans showed that 16 cases (40%) in Group I and 32 cases (80%) in Group II had evidence of at least unilateral continuous bridging bone between neighboring vertebrae at 24 months (p<.05).
We have confirmed the hypothesis that the autologous BMC together with the allograft is a better alternative for PLF than the allograft alone. The use of autologous MSCs in form of BMC in combination with allograft is an effective option to enhance the PLF healing.
在腰椎疾病的手术治疗中，脊柱融合术一直是众多研究的主题。经皮椎弓根螺钉固定后路椎体间融合术（posterior lumbar fusion，PLF）是一种常用的方法。
确定在经后路腰椎融合术（instrumented posterior lumbar fusion，PLF）中加入骨髓浓缩物（bone marrow concentrate，BMC）是否能提高植骨融合率。
本研究为前瞻性、随机、对照、盲法研究。
80 例退行性腰椎疾病患者接受后路腰椎或腰骶段 PLF 治疗（22 例男性，58 例女性；BMI 小于 35，以便在 X 线片上更好地观察 PLF）。在 40 例中，PLF 仅使用松质骨移植物（组 I，平均年龄 62.7 岁，范围 47-77 岁，融合节段 1-2 个）。在另 40 例中，PLF 使用松质骨移植物与 BMC（组 II，平均年龄 58.5 岁，范围 42-80 岁，融合节段 1-3 个）混合，包括间充质干细胞（mesenchymal stem cells，MSCs）。术后 12 个月和 24 个月分别拍摄前后位和侧位 X 线片，术后 24 个月进行 CT 扫描。两名放射科医生对患者分组情况不知情，分别对融合状态和融合质量的矿化程度进行评估。如果在横突或骶骨之间有连续的矿化良好的骨桥，并且脊柱的一侧至少有骨小梁形成表明骨成熟，则判断骨块融合。
在组 I 中，在术后 12 个月时，X 线片上评估的骨移植物质量无一例（0%）融合，在术后 24 个月时融合 4 例（10%）。在组 II 中，术后 12 个月有 6 例（15%）和 24 个月有 14 例（35%）融合。两组在 12 个月（p=.041）和 24 个月（p=.011）时完全融合的统计学差异均有显著意义。CT 扫描显示，术后 24 个月时，组 I 中有 16 例（40%）和组 II 中有 32 例（80%）至少有一侧相邻椎体间存在连续的桥接骨（p<.05）。
我们已经证实了这样的假设，即自体 BMC 与同种异体骨联合使用是 PLF 的一种更好的选择，优于单纯同种异体骨。自体 MSCs 以 BMC 的形式与同种异体骨联合使用是增强 PLF 愈合的有效选择。
