Buser Zorica, Brodke Darrel S, Youssef Jim A, Rometsch Elke, Park Jong-Beom, Yoon S Tim, Wang Jeffrey C, Meisel Hans-Joerg
University of Southern California, Los Angeles, CA, USA.
University of Utah, Salt Lake City, UT, USA.
Global Spine J. 2018 Jun;8(4):396-412. doi: 10.1177/2192568217735342. Epub 2017 Oct 25.
Systematic review.
The aim was to determine the fusion efficacy of allograft and demineralized bone matrix (DBM) in lumbar instrumented and noninstrumented fusion procedures for degenerative lumbar disorders.
A literature search was conducted using the PubMed and Cochrane databases. To be considered, publications had to meet 4 criteria: patients were treated for a degenerative lumbar disorder, a minimum group size of 10 patients, use of allograft or DBM, and at least a 2-year follow-up. Data on the study population, follow-up time, surgery type, grafting material, fusion rates, and its definition were collected.
The search yielded 692 citations with 17 studies meeting the criteria including 4 retrospective and 13 prospective studies. Six studies used DBM and 11 employed allograft alone or in the combination with autograft. For the allograft, fusion rates ranged from 58% to 68% for noninstrumented and from 68% to 98% for instrumented procedures. For DBM, fusion rates were 83% for noninstrumented and between 60% and 100% for instrumented lumbar fusion procedures.
Both allograft and DBM appeared to provide similar fusion rates in instrumented fusions. On the other hand, in noninstrumented procedures DBM was superior. However, a large variation in the type of surgery, outcomes collection, lack of control groups, and follow-up time prevented any significant conclusions. Thus, studies comparing the performance of allograft and DBM to adequate controls in large, well-defined patient populations and with a sufficient follow-up time are needed to establish the efficacy of these materials as adjuncts to fusion.
系统评价。
旨在确定同种异体骨和脱矿骨基质（DBM）在退行性腰椎疾病的腰椎器械辅助融合和非器械辅助融合手术中的融合效果。
使用PubMed和Cochrane数据库进行文献检索。纳入的出版物必须符合4条标准：患者接受退行性腰椎疾病治疗、每组最小样本量为10例患者、使用同种异体骨或DBM、以及至少2年的随访。收集关于研究人群、随访时间、手术类型、移植材料、融合率及其定义的数据。
检索得到692条引用文献，其中17项研究符合标准，包括4项回顾性研究和13项前瞻性研究。6项研究使用DBM，11项研究单独使用同种异体骨或与自体骨联合使用。对于同种异体骨，非器械辅助融合的融合率为58%至68%，器械辅助融合的融合率为68%至98%。对于DBM，非器械辅助融合的融合率为83%，器械辅助腰椎融合手术的融合率在60%至100%之间。
在器械辅助融合中，同种异体骨和DBM的融合率似乎相似。另一方面，在非器械辅助手术中，DBM更具优势。然而，手术类型、结果收集、缺乏对照组以及随访时间的巨大差异阻碍了得出任何有意义的结论。因此，需要在大型、明确界定的患者群体中进行比较同种异体骨和DBM性能并设置适当对照且随访时间充足的研究，以确定这些材料作为融合辅助材料的疗效。
