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单纯使用脱钙骨基质或低浓度大肠杆菌来源 rhBMP-2 行微创侧方腰椎间融合术患者的影像学和临床结局的对比研究

Comparative Study of Radiological and Clinical Outcomes in Patients Undergoing Minimally Invasive Lateral Lumbar Interbody Fusion Using Demineralized Bone Matrix Alone or with Low-Dose Escherichia coli-Derived rhBMP-2.

机构信息

Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju-si, Jeju-do, Republic of Korea.

Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Yongsan-gu, Seoul, Republic of Korea.

出版信息

World Neurosurg. 2022 Feb;158:e557-e565. doi: 10.1016/j.wneu.2021.11.028. Epub 2021 Nov 11.

Abstract

OBJECTIVE

To compare the results of interbody fusion in patients undergoing minimally invasive lateral lumbar interbody fusion (LLIF) using demineralized bone matrix (DBM) alone versus DBM+recombinant human bone morphogenetic protein-2 (rhBMP2).

METHODS

This retrospective case-controlled study was conducted in patients undergoing minimally invasive LLIF (n = 54) for lumbar interbody fusion; they were divided into 2 groups: DBM-only group and DMB+rhBMP2 group. The improvements of segmental and lumbar lordosis and restoration of disc height were measured, and the interbody fusion rates were determined using a modified Bridwell grading system. Clinical outcomes after surgery, such as visual analog scale scores of back pain and leg pain, and Oswestry disability index were compared.

RESULTS

There were no significant differences in disc height, lumbar and segmental lordosis, or interbody fusion rate between the 2 groups. However, the proportion of Bridwell grade 1 as complete interbody bridging was higher in the DBM+rhBMP2 group than in the DBM-only group at both 6 and 12 months (P < 0.001). Clinical parameters showed equally significant improvement during follow-up in both groups, with no significant differences between the groups.

CONCLUSION

In minimally invasive LLIF, adding Escherichia coli-derived rhBMP2 to DBM did not affect clinical outcomes or radiation parameters, but increased the speed of fusion and interbody bony bridging rate.

摘要

目的

比较单独使用脱钙骨基质(DBM)与 DBM+重组人骨形态发生蛋白-2(rhBMP2)进行微创侧路腰椎间融合术(LLIF)患者的椎间融合结果。

方法

本回顾性病例对照研究纳入了 54 例行微创 LLIF 治疗腰椎间融合的患者;将其分为 2 组:DBM 组和 DBM+rhBMP2 组。测量了节段和腰椎前凸的改善以及椎间盘高度的恢复,并使用改良 Bridwell 分级系统确定椎间融合率。比较术后临床结果,如腰背疼痛的视觉模拟评分和 Oswestry 残疾指数。

结果

2 组间椎间盘高度、腰椎前凸和节段前凸或椎间融合率无显著差异。然而,在 6 个月和 12 个月时,DBM+rhBMP2 组 Bridwell 分级 1 级(完全椎间桥接)的比例均高于 DBM 组(P < 0.001)。在随访期间,2 组的临床参数均显著改善,组间无显著差异。

结论

在微创 LLIF 中,向 DBM 中添加大肠杆菌衍生的 rhBMP2 不会影响临床结果或放射学参数,但会加快融合速度和椎间骨桥接率。

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