Morris Matthew T, Tarpada Sandip P, Cho Woojin
Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, NY, USA.
Department of Orthopaedic Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, Bronx, NY, 10467-2404, USA.
Eur Spine J. 2018 Aug;27(8):1856-1867. doi: 10.1007/s00586-018-5511-6. Epub 2018 Feb 14.
Iliac crest has long been the gold standard for lumbar fusion, but concerns over donor site morbidity have led to a wide variety of bone graft substitutes. Despite prolific research, a general consensus is yet to be reached on bone graft materials that lead to optimal fusion.
The purpose of this review is to evaluate the current literature for bone graft material options that maximize fusion rate in posterolateral lumbar fusion surgery.
Systematic Review.
A PRISMA-compliant systematic review of PubMed, EMBASE, and the Web of Science was conducted. Included studies were published from January 2000 to July 2015, were clinical human research studies involving available autograft, allograft, or synthetic bone graft options in posterolateral lumbar spine fusion, and reported radiographic fusion rate as a primary end outcome. This research had no funding source and the authors have no conflicts to declare.
81 articles underwent full-text review, and 48 were included in this study. 18 studies assessed fusion rate by plain radiographs alone (37.5%), while 6 used CT scan (12.5%), and 24 used both (50.0%). 45 studies looked at ICBG in conjunction with LAG (29), BCP(1), APC (2), BMPs (6), or DBM (1). Aggregate mean fusion rates among these ranged from 68.0 to 91.5%. 22 studies evaluated fusion rates of LAG, either isolated (3) or combined with ceramic extenders (8), DBM (4), BMP (1), BMA (4), APC (1), or ICBG(1). Aggregate mean fusion rate ranged from 75 to 95.5%. With the exception of studies involving allograft (mean fusion rate 40.0%), the mean fusion rate for all other graft combinations exceeded 70.0%.
While our results find that LAG+BMA provided highest fusion rate, most material options analyzed in this study provide comparable fusion outcomes. The ideal graft option must incorporate a combination of materials with osteoconductive, osteoinductive, and osteogenic properties. Our results represent the robust and dynamic nature of the current state of lumbar graft technology. These slides can be retrieved under Electronic Supplementary Material.
长期以来，髂嵴一直是腰椎融合术的金标准，但对供区并发症的担忧促使人们研发了多种骨移植替代物。尽管进行了大量研究，但对于能实现最佳融合的骨移植材料尚未达成普遍共识。
本综述的目的是评估当前关于能使后外侧腰椎融合手术融合率最大化的骨移植材料选择的文献。
系统评价。
按照PRISMA标准对PubMed、EMBASE和科学网进行系统评价。纳入的研究发表于2000年1月至2015年7月，是涉及后外侧腰椎融合术中可用自体骨移植、异体骨移植或合成骨移植选择的临床人体研究，且将影像学融合率作为主要结局指标进行报告。本研究无资金来源，作者无利益冲突声明。
81篇文章接受了全文审查，48篇被纳入本研究。18项研究仅通过X线平片评估融合率（37.5%），6项使用CT扫描（1,2.5%），24项同时使用两者（50.0%）。45项研究观察了髂嵴骨移植联合局部自体移植骨（29项）、磷酸钙骨水泥（1项）、人工骨（2项）、骨形态发生蛋白（6项）或脱细胞骨基质（1项）的情况。这些研究中的总体平均融合率在68.0%至91.5%之间。22项研究评估了局部自体移植骨的融合率，单独使用（3项）或与陶瓷增强材料（8项）、脱细胞骨基质（4项）、骨形态发生蛋白（1项）、骨基质明胶（4项）、人工骨（1项）或髂嵴骨移植（1项）联合使用。总体平均融合率在75%至95.5%之间。除了涉及异体骨移植的研究（平均融合率40.0%）外，所有其他移植组合的平均融合率均超过70.0%。
虽然我们的结果发现局部自体移植骨+骨基质明胶提供了最高的融合率，但本研究中分析的大多数材料选择提供了相当的融合结果。理想的移植选择必须包含具有骨传导性、骨诱导性和成骨特性的材料组合。我们的结果代表了当前腰椎移植技术的强大和动态性质。这些幻灯片可在电子补充材料中获取。
