Chang Ki-Eun, Mesregah Mohamed Kamal, Fresquez Zoe, Stanton Eloise W, Buser Zorica, Wang Jeffrey C
Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 San Pablo St., HC4, Suite 5400A, Los Angeles, CA, 90003, USA.
Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shibin el Kom, Egypt.
Spine Deform. 2022 Nov;10(6):1217-1231. doi: 10.1007/s43390-022-00529-1. Epub 2022 Jun 23.
The aim of the current review is to summarize the current evidence on graft materials used in fusion procedures for spinal deformity corrections.
PubMed, Embase, and Cochrane Library were searched for relevant published observational studies and clinical trials using osteobiologics and biomaterials in spinal deformity surgery.
The use of autograft in deformity correction surgeries has been reported in a limited number of studies, with the harvest sites including iliac crest, ribs, and local bone. Various allografts and biologics have been used in the treatment of spinal deformities including idiopathic and degenerative scoliosis, either as stand alone or in combination with autograft. Limited number of studies reported no differences in fusion rates or outcomes. Use of rh-BMP2 in anterior, posterior or front/back approaches showed higher fusion rates than other graft materials in patients with spinal deformities. Due to the limited number of quality studies included in the review, as well as alternative factors, such as costs, availability, and surgeon expertise/preference, no definitive conclusion or recommendations can be made as to the ideal graft choice in spinal deformity surgery.
Most commonly used grafts included autograft, allograft and rh-BMP2, with new biologics and biomaterials constantly emerging in the market. Limited number of high-quality comparative studies and heterogeneity in study design prevented direct comparisons that can lead to meaningful recommendations. Further studies are needed to prove superiority of any single graft material and/or biologic that is also cost-effective and safe.
本综述的目的是总结目前关于用于脊柱畸形矫正融合手术的移植材料的证据。
检索PubMed、Embase和Cochrane图书馆，查找在脊柱畸形手术中使用骨生物制剂和生物材料的相关已发表观察性研究和临床试验。
在少数研究中报道了自体骨移植在畸形矫正手术中的应用，取材部位包括髂嵴、肋骨和局部骨。各种同种异体骨和生物制剂已用于治疗脊柱畸形，包括特发性和退行性脊柱侧凸，可单独使用或与自体骨联合使用。少数研究报告融合率或结果无差异。在脊柱畸形患者中，在前方、后方或前后联合入路中使用重组人骨形态发生蛋白-2（rh-BMP2）显示出比其他移植材料更高的融合率。由于本综述纳入的高质量研究数量有限，以及成本、可用性和外科医生专业知识/偏好等其他因素，对于脊柱畸形手术中理想的移植选择无法得出明确结论或建议。
最常用的移植材料包括自体骨、同种异体骨和rh-BMP2，市场上不断有新的生物制剂和生物材料出现。高质量比较研究数量有限以及研究设计的异质性阻碍了能得出有意义建议的直接比较。需要进一步研究来证明任何单一移植材料和/或生物制剂的优越性，同时还要具有成本效益和安全性。
