Department of Pediatric Orthopaedic Surgery, Children's Hospital, Hamburg-Altona, Hamburg, Germany.
Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Mater Sci Mater Med. 2018 Jun 25;29(7):93. doi: 10.1007/s10856-018-6104-y.
In pediatric spine surgery nonunion is a challenging issue. Instability may cause neurological impairment and lead to numerous surgeries in order to achieve fusion. The use of rhBMP-2 for pediatric spinal fusion has not been widely reported. In this study, a series of 13 children (14 procedures) that underwent spinal rhBMP-2 application were analyzed in order to measure clinical and radiographic outcome. Therefore, patient data, diagnosis, construct of instrumentation, type of bone graft, quantity of BMP used, and fusion outcome were reviewed. The study cohort included four female and nine male patients with a mean age of 11.2 years (range 2.6-19.2 years) at the time of rhBMP-2 application. Rh-BMP-2 was used in both primary (n = 6) and revision surgery (n = 8) in patients with a high risk for the development of nonunion. The mean follow-up was 51 months (range 12-108 months). Fusion occurred in 11 patients. Complications that may be due to application of rhBMP-2 were seen after four operations. Three patients had an increased body temperature and in one case prolonged wound secretion was evident, treated by local wound care or observation. In one of these patients an extensive postoperative hematoma occurred, necessitating surgical treatment. In conclusion, we could detect high fusion rates following the use of rhBMP-2 in pediatric spine surgery without an increased complication rate attributable to its application. Therefore we consider recombinant human BMP-2 to be an option in selected pediatric spinal procedures, especially in cases with compromised bone healing due to congenital, systemic, or local conditions.
在小儿脊柱外科中，骨不连是一个具有挑战性的问题。不稳定可能导致神经功能障碍，并导致需要进行多次手术以实现融合。rhBMP-2 用于小儿脊柱融合的应用尚未广泛报道。在这项研究中，分析了一系列接受脊柱 rhBMP-2 应用的 13 名儿童（14 例手术），以衡量临床和影像学结果。因此，回顾了患者数据、诊断、器械结构、植骨类型、使用的 BMP 量和融合结果。研究队列包括 4 名女性和 9 名男性患者，在 rhBMP-2 应用时的平均年龄为 11.2 岁（范围 2.6-19.2 岁）。rh-BMP-2 用于 6 例初次手术和 8 例翻修手术中，这些患者有发生骨不连的高风险。平均随访时间为 51 个月（范围 12-108 个月）。11 名患者融合成功。在 4 例手术后出现了可能与 rhBMP-2 应用有关的并发症。有 3 名患者体温升高，1 例患者伤口分泌物延长，通过局部伤口护理或观察进行治疗。在其中 1 例患者中，发生广泛的术后血肿，需要手术治疗。总之，我们可以在小儿脊柱外科中使用 rhBMP-2 后检测到高融合率，而不会因应用其而导致并发症发生率增加。因此，我们认为重组人 BMP-2 是小儿脊柱手术的一种选择，特别是在因先天性、全身性或局部因素导致骨愈合受损的情况下。
