Li Guanbao, Li Pinquan, Chen Qiuan, Thu Hnin Ei, Hussain Zahid
Department of Minimally Invasive Spine Surgery, Yulin City Orthopaedic Hospital of Traditional Chinese Medicine and Western Medicine, NO.597, Jiaoyu Road, Yulin, Guangxi, 537000, China.
Department of Pharmacology and Dental Therapeutics, Faculty of Dentistry, Lincoln University College, Jalan Stadium, SS 7/15, Kelana Jaya, 47301 Petaling Jaya, Selangor, Malaysia.
Curr Drug Deliv. 2019;16(2):94-110. doi: 10.2174/1567201815666181024142354.
Owing to their great promise in the spinal surgeries, bone graft substitutes have been widely investigated for their safety and clinical potential. By the current advances in the spinal surgery, an understanding of the precise biological mechanism of each bone graft substitute is mandatory for upholding the induction of solid spinal fusion.
The aim of the present review is to critically discuss various surgical implications and level of evidence of most commonly employed bone graft substitutes for spinal fusion.
Data was collected via electronic search using "PubMed", "SciFinder", "ScienceDirect", "Google Scholar", "Web of Science" and a library search for articles published in peer-reviewed journals, conferences, and e-books.
Despite having exceptional inherent osteogenic, osteoinductive, and osteoconductive features, clinical acceptability of autografts (patient's own bone) is limited due to several perioperative and postoperative complications i.e., donor-site morbidities and limited graft supply. Alternatively, allografts (bone harvested from cadaver) have shown great promise in achieving acceptable bone fusion rate while alleviating the donor-site morbidities associated with implantation of autografts. As an adjuvant to allograft, demineralized bone matrix (DBM) has shown remarkable efficacy of bone fusion, when employed as graft extender or graft enhancer. Recent advances in recombinant technologies have made it possible to implant growth and differentiation factors (bone morphogenetic proteins) for spinal fusion.
Selection of a particular bone grafting biotherapy can be rationalized based on the level of spine fusion, clinical experience and preference of orthopaedic surgeon, and prevalence of donor-site morbidities.
由于骨移植替代物在脊柱手术中具有巨大潜力，因此对其安全性和临床潜力进行了广泛研究。随着脊柱手术的当前进展，了解每种骨移植替代物的确切生物学机制对于促进坚实的脊柱融合诱导至关重要。
本综述的目的是批判性地讨论最常用的用于脊柱融合的骨移植替代物的各种手术意义和证据水平。
通过使用“PubMed”、“SciFinder”、“ScienceDirect”、“谷歌学术”、“Web of Science”进行电子搜索以及在图书馆搜索同行评审期刊、会议和电子书中发表的文章来收集数据。
尽管自体骨（患者自身的骨）具有出色的固有成骨、骨诱导和骨传导特性，但由于一些围手术期和术后并发症，即供区并发症和有限的移植物供应，其临床可接受性受到限制。相比之下，同种异体骨（从尸体获取的骨）在实现可接受的骨融合率同时减轻与自体骨植入相关的供区并发症方面显示出巨大潜力。作为同种异体骨的辅助材料，脱矿骨基质（DBM）在用作移植物扩展剂或移植物增强剂时已显示出显著的骨融合功效。重组技术的最新进展使得植入生长和分化因子（骨形态发生蛋白）用于脊柱融合成为可能。
特定骨移植生物疗法的选择可以根据脊柱融合水平、骨科医生的临床经验和偏好以及供区并发症的发生率来合理化。
